An epidural blood patch, once or more, targeted or distant, at one site or bilevel, has emerged as the treatment of choice for those who have failed the conservative measures. Epidural injection of fibrin glue of both blood and fibrin glue can be considered in selected cases. Surgery to stop the leak is considered when the

exact site of the leak has been determined by neurodiagnostic studies and when less invasive measures have failed. Subdural hematomas sometimes complicate the CSF leaks; a rebound intracranial hypertension after successful treatment of a leak is not rare. Cerebral venous sinus thrombosis as a complication is fortunately less common, and superficial siderosis and bibrachial amyotrophy are rare. Short-term recurrences are not uncommon, and long-term recurrences are not rare. In 1891, learn more lumbar puncture (LP) was introduced independently by Heinrich Quincke of Germany (aimed at treatment of hydrocephalus)[1] and W. Essex Wynter of England (aimed at alleviation of pressure in tuberculous meningitis).[2]

In 1898, having recognized post-LP headaches, August Beir (a student of Quincke) along with his assistant, August Hildebrandt, performed experiments upon themselves and suffered post-LP headaches.[3] In 1939, Georg Schaltenbrand, a German neurologist, using the term “aliquorrhea” described spontaneous occurrence of a syndrome of orthostatic headache and a few Staurosporine ic50 other symptoms associated with low cerebrospinal fluid (CSF) opening pressure (OP).[4] This later came to be known as spontaneous intracranial hypotension CHIR-99021 research buy (SIH).[5, 6] Modern neuroimaging has revolutionized our understanding of this entity. The original theory of Schaltenbrand that the disorder was due to decreased CSF production has never been substantiated. It is now recognized that almost all cases of SIH result from spontaneous CSF leaks. The overwhelming majority of these spontaneous leaks occur at the spinal level and only rarely from the skull base. In contrast, posttraumatic or postsurgical CSF leaks from the skull base (rhinorrhea, otorrhea) are not rare at all. The first report on pachymeningeal

enhancement in intracranial hypotension appeared about two decades ago.[6] In this interval, additional imaging features of the disorder have been recognized, and far more patients are diagnosed than previously.[7-10] A broad clinical spectrum of the disorder has come to be recognized. SIH can no longer be simply equated with postdural puncture headaches.[11] Although the triad of orthostatic headaches, low CSF pressures, and diffuse pachymeningeal enhancement is the classic hallmark of this disorder, the variability is indeed substantial. This includes patients who do not display meningeal enhancement,[12] those who may not have headaches, or patients who may show CSF OPs that are well within normal limits.