Hypotension, Intracranial

Intracranial hypotension can be caused by multiple conditions, such as CSF leak (spontaneous vs. traumatic), over-shunting, or CSF-venous fistula[1], etc.



This patient presented with progressively worsening headaches. Brain MRI with and without contrast suggested intracranial hypotension with bilateral subdural hygromas (A), diffuse pathymeningeal enhancement (B, C, and D), and crowded foramen magnum (E). MRI neuraxis with and without contrast also showed diffuse dural enhancement (not shown) without an identifiable CSF leak. A CT myelogram showed contrast extravasation within the left neural foramen at C7-T1 (F and G), suspecting a CSF-venous fistula. The patient subsequently underwent a diagnostic venogram (H and I) and Onyx embolization of the left C7-T1 paraspinal venous network (J and K).[2] Post-operatively, patient's headache resolved.

Intervention Specifics:

* This case is also published in note CSF-Venous Fistula.

  1. Cerebrospinal Fluid-Venous Fistulas: A Systematic Review and Examination of Individual Patient Data - PubMed ↩︎

  2. A Novel Endovascular Therapy for CSF Hypotension Secondary to CSF-Venous Fistulas - PMC ↩︎