Spontaneous intracranial hypotension (SIH): other investigations
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Spontaneous intracranial hypotension (SIH): other investigations. Low opening pressure. Fully referenced neurology checklist.
Lumbar puncture (LP): features
- Low opening pressure
- Lymphocytic pleocytosis: up to 200 cells/cubic mm
- Increased protein: up to 1g
- Xanthochromia
- Decreased CSF flow
- A sucking noise may be heard at LP: this is due to air being drawn into the CSF space
Computed tomography (CT) myelogram: features
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Digital subtraction myelography
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Radionuclide cisternography
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Transorbital ultrasound
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References
- Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295:2286-2296.
- Schievink WI, Reimer R, Folger WN. Surgical treatment of spontaneous intracranial hypotension associated with a spinal arachnoid diverticulum. J Neurosurg 1994; 80:736-739.
- Clark MS, Diehn FE, Verdoorn JT, et al. Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography. Diagn Interv Radiol 2018; 24:54-59.
- Kranz PG, Amrhein TJ, Schievink WI, Karikari IO, Gray L. The "hyperdense paraspinal vein" sign: a marker of CSF-venous fistula. Am J Neuroradiol 2016; 37:1379-1381.
- Duvall JR, Robertson CE, Whealy MA, Garza I. Clinical Reasoning: an underrecognized etiology of new daily persistent headache. Neurology 2020; 94:e114-e120.
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