Low-pressure syndromes and cerebrospinal fluid leaks: Diagnosis and management

Debraj Mukherjee, Wouter I. Schievink

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Cerebrospinal fluid (CSF) leaks are increasingly considered an important cause of low-pressure headaches, particularly among younger patients [1]. While rigorous epidemiological evidence is lacking, several series have documented the relative incidence of CSF leak from varying etiologies. Approximately 80% of CSF fistulae with rhinorrhea have been reported to be caused by nonsurgical trauma and 16% by surgical trauma, with the remaining 4% having nontraumatic etiology [2]. Of course, for patients with spontaneous intracranial hypotension, the underlying CSF leak should be looked for in the spine and not at the level of the skull base [3]. Spontaneous intracranial hypotension has been estimated to range between 1 per 50 000 to 5 per 100 000 persons in community-based and emergency department based settings, respectively [4,5]. Spontaneous intracranial hypotension affects women twice as frequently as men and typically presents in the fourth or fifth decade of life, though the specific pathophysiological reason for this demographic trend is currently unknown [6–16]. Pathogenesis The specific etiology underlying spontaneous CSF leaks remains largely unknown, but underlying structural weakness of the spinal meninges is suspected, though a history of trauma may be elicited in up to a third of patients [14,17–19]. This dural weakness, ranging from simple dural tears to meningeal diverticula, allows CSF to leak into the epidural [20,21]. Ventral spinal CSF leaks are often seen at the level of the disk space and may be associated with degenerative disk disease.

Original languageEnglish (US)
Title of host publicationAdult Hydrocephalus
PublisherCambridge University Press
Pages256-263
Number of pages8
ISBN (Electronic)9781139382816
ISBN (Print)9781107031777
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Intracranial Hypotension
Pressure
Wounds and Injuries
Meninges
Diverticulum
Skull Base
Tears
Fistula
Headache
Cerebrospinal Fluid
Cerebrospinal Fluid Leak
Hospital Emergency Service
Spine
Demography
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mukherjee, D., & Schievink, W. I. (2012). Low-pressure syndromes and cerebrospinal fluid leaks: Diagnosis and management. In Adult Hydrocephalus (pp. 256-263). Cambridge University Press. https://doi.org/10.1017/CBO9781139382816.023

Low-pressure syndromes and cerebrospinal fluid leaks : Diagnosis and management. / Mukherjee, Debraj; Schievink, Wouter I.

Adult Hydrocephalus. Cambridge University Press, 2012. p. 256-263.

Research output: Chapter in Book/Report/Conference proceedingChapter

Mukherjee, D & Schievink, WI 2012, Low-pressure syndromes and cerebrospinal fluid leaks: Diagnosis and management. in Adult Hydrocephalus. Cambridge University Press, pp. 256-263. https://doi.org/10.1017/CBO9781139382816.023
Mukherjee, Debraj ; Schievink, Wouter I. / Low-pressure syndromes and cerebrospinal fluid leaks : Diagnosis and management. Adult Hydrocephalus. Cambridge University Press, 2012. pp. 256-263
@inbook{3d3966e927c24400b6aa8401aefaef41,
title = "Low-pressure syndromes and cerebrospinal fluid leaks: Diagnosis and management",
abstract = "Cerebrospinal fluid (CSF) leaks are increasingly considered an important cause of low-pressure headaches, particularly among younger patients [1]. While rigorous epidemiological evidence is lacking, several series have documented the relative incidence of CSF leak from varying etiologies. Approximately 80{\%} of CSF fistulae with rhinorrhea have been reported to be caused by nonsurgical trauma and 16{\%} by surgical trauma, with the remaining 4{\%} having nontraumatic etiology [2]. Of course, for patients with spontaneous intracranial hypotension, the underlying CSF leak should be looked for in the spine and not at the level of the skull base [3]. Spontaneous intracranial hypotension has been estimated to range between 1 per 50 000 to 5 per 100 000 persons in community-based and emergency department based settings, respectively [4,5]. Spontaneous intracranial hypotension affects women twice as frequently as men and typically presents in the fourth or fifth decade of life, though the specific pathophysiological reason for this demographic trend is currently unknown [6–16]. Pathogenesis The specific etiology underlying spontaneous CSF leaks remains largely unknown, but underlying structural weakness of the spinal meninges is suspected, though a history of trauma may be elicited in up to a third of patients [14,17–19]. This dural weakness, ranging from simple dural tears to meningeal diverticula, allows CSF to leak into the epidural [20,21]. Ventral spinal CSF leaks are often seen at the level of the disk space and may be associated with degenerative disk disease.",
author = "Debraj Mukherjee and Schievink, {Wouter I.}",
year = "2012",
month = "1",
day = "1",
doi = "10.1017/CBO9781139382816.023",
language = "English (US)",
isbn = "9781107031777",
pages = "256--263",
booktitle = "Adult Hydrocephalus",
publisher = "Cambridge University Press",

}

TY - CHAP

T1 - Low-pressure syndromes and cerebrospinal fluid leaks

T2 - Diagnosis and management

AU - Mukherjee, Debraj

AU - Schievink, Wouter I.

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Cerebrospinal fluid (CSF) leaks are increasingly considered an important cause of low-pressure headaches, particularly among younger patients [1]. While rigorous epidemiological evidence is lacking, several series have documented the relative incidence of CSF leak from varying etiologies. Approximately 80% of CSF fistulae with rhinorrhea have been reported to be caused by nonsurgical trauma and 16% by surgical trauma, with the remaining 4% having nontraumatic etiology [2]. Of course, for patients with spontaneous intracranial hypotension, the underlying CSF leak should be looked for in the spine and not at the level of the skull base [3]. Spontaneous intracranial hypotension has been estimated to range between 1 per 50 000 to 5 per 100 000 persons in community-based and emergency department based settings, respectively [4,5]. Spontaneous intracranial hypotension affects women twice as frequently as men and typically presents in the fourth or fifth decade of life, though the specific pathophysiological reason for this demographic trend is currently unknown [6–16]. Pathogenesis The specific etiology underlying spontaneous CSF leaks remains largely unknown, but underlying structural weakness of the spinal meninges is suspected, though a history of trauma may be elicited in up to a third of patients [14,17–19]. This dural weakness, ranging from simple dural tears to meningeal diverticula, allows CSF to leak into the epidural [20,21]. Ventral spinal CSF leaks are often seen at the level of the disk space and may be associated with degenerative disk disease.

AB - Cerebrospinal fluid (CSF) leaks are increasingly considered an important cause of low-pressure headaches, particularly among younger patients [1]. While rigorous epidemiological evidence is lacking, several series have documented the relative incidence of CSF leak from varying etiologies. Approximately 80% of CSF fistulae with rhinorrhea have been reported to be caused by nonsurgical trauma and 16% by surgical trauma, with the remaining 4% having nontraumatic etiology [2]. Of course, for patients with spontaneous intracranial hypotension, the underlying CSF leak should be looked for in the spine and not at the level of the skull base [3]. Spontaneous intracranial hypotension has been estimated to range between 1 per 50 000 to 5 per 100 000 persons in community-based and emergency department based settings, respectively [4,5]. Spontaneous intracranial hypotension affects women twice as frequently as men and typically presents in the fourth or fifth decade of life, though the specific pathophysiological reason for this demographic trend is currently unknown [6–16]. Pathogenesis The specific etiology underlying spontaneous CSF leaks remains largely unknown, but underlying structural weakness of the spinal meninges is suspected, though a history of trauma may be elicited in up to a third of patients [14,17–19]. This dural weakness, ranging from simple dural tears to meningeal diverticula, allows CSF to leak into the epidural [20,21]. Ventral spinal CSF leaks are often seen at the level of the disk space and may be associated with degenerative disk disease.

UR - http://www.scopus.com/inward/record.url?scp=84924678323&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924678323&partnerID=8YFLogxK

U2 - 10.1017/CBO9781139382816.023

DO - 10.1017/CBO9781139382816.023

M3 - Chapter

AN - SCOPUS:84924678323

SN - 9781107031777

SP - 256

EP - 263

BT - Adult Hydrocephalus

PB - Cambridge University Press

ER -