What Is Intracranial Hypotension?

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Intracranial hypotension is a medical condition in which pressure or volume in the brain cavity is below normal levels due to low cerebrospinal fluid (CSF) levels. CSF is a clear, thick liquid that supports and cushions the brain and spinal cord. The reduced CSF causes a negative pressure within the skull, leading to headaches, dizziness, nausea, memory impairment, and other neurological symptoms.

This article discusses intracranial hypotension symptoms, causes, diagnosis, and treatment.

Doctor performing brain surgery on patient

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Intracranial Hypotension Symptoms

The most common symptom of intracranial hypotension is severe headaches.

Positional headaches feel better with lying down. They usually get worse throughout the day as a person has been standing up, and CSF leaks with the effects of gravity.

Other symptoms of intracranial hypotension include:

  • Nausea and vomiting
  • Neck pain and stiffness
  • Tinnitus (ringing, buzzing, or other sounds in the ear)
  • Sensitivity to light or sound
  • Hearing disturbances
  • Dizziness
  • Confusion
  • Movement disorders

Causes

Intracranial hypotension stems from having too little CSF to cushion and support the brain. This decrease typically results from a CSF leak in a tissue layer called the dura mater (dura), the outermost layer of connective tissue that encompasses the meninges of the brain.

The dura helps to protect and surround the brain and spinal cord. A hole or tear in the dura is the cause of intracranial hypertension.

There are many reasons why a hole or tear may occur, such as:

  • Lumbar puncture (spinal tap)
  • Injury or trauma to the brain or spine
  • A weakness in the dura
  • Spinal surgery
  • An epidural
  • Calcified disks or bone spurs (bony projections along bone edges) of the spine that tear the dura

Diagnosis

Healthcare providers who suspect intracranial hypotension based on neurological symptoms may order one or more diagnostic tests, such as:

  • Magnetic resonance imaging (MRI): A machine that uses magnets and radio waves to collect anatomical images. MRIs of the brain and spinal cord can help identify a CSF leak.
  • Computed tomography (CT): A diagnostic test that uses a series of X-rays from multiple angles to create cross-sectional images or sliced images.
  • Lumbar puncture (LP): An LP is less commonly used for diagnosis but may be used to measure the CSF opening pressure at the source of the leak.

Treatment

Fortunately, intracranial hypotension usually resolves on its own and requires no medical intervention in most cases.

However, in cases in which this condition does not heal itself or is more severe, other procedures may be necessary.

Epidural Blood Patching

An epidural blood patch (EBP) is an injection of a person's own blood, called autologous blood, into the epidural space. This procedure helps by sealing the dural tear and stopping CSF fluid from leaking.

Surgery

If EBP is ineffective after at least two tries, surgery by an experienced healthcare provider in surgical intracranial hypertension management may be an option.

Surgical options may include:

  • Clipping of leaking meningeal diverticula
  • Direct repair of dural tears
  • Strengthening the dura with a procedure called a duroplasty
  • Packing the epidural space with surgical glue

Occasionally, patients may develop "rebound intracranial hypertension," or elevated CSF pressure after treatment. The most commonly used medication to counteract increased CSF pressure, in this case, is called Diamox (acetazolamide), a diuretic used for reducing fluid buildup in the body.

Prognosis

The prognosis for most people who experience intracranial hypotension is positive. In most cases, this condition resolves independently without medical intervention. However, long-term prognosis and treatment become trickier if people need additional intervention.

The long-term prognosis depends on the severity of the dural tear or leak. If you have intracranial hypotension, it is essential to discuss the prognosis with your healthcare provider.

Coping

Coping with this condition varies and depends on its severity.

Managing mild and nonoperative intracranial hypotension symptoms often involves taking some downtime to allow the leak to heal. Other simple coping measures that your healthcare provider may recommend to manage uncomfortable symptoms include:

  • Bed rest
  • Hydration
  • Caffeine

Discuss potential coping methods with your healthcare provider to see what they recommend for you.

Summary

Intracranial hypotension is a condition in which pressure in the brain cavity is below average due to low cerebrospinal fluid (CSF) levels. The most common symptom experienced by people with intracranial hypotension is headaches. Other symptoms may include nausea, neck pain, tinnitus, and sensitivity to light or sound.

Intracranial hypertension is caused by a hole or tear in the dura. This defect may occur as a side effect of an epidural, lumbar puncture, injury or trauma, spine surgery, or a weakness in the dura.

Fortunately, most people with intracranial hypotension require no medical intervention, and the condition resolves independently. However, in cases where this condition does not heal itself or is more severe, surgery or other procedures may be required, such as EBP patching or surgery.

A Word From Verywell

Intracranial hypotension can be painful, frightening, and even debilitating. Fortunately, it typically resolves on its own and no invasive treatment is required. If intervention is needed, there are effective treatment options available.

This condition may take time to heal, so it's essential to rest and take care of yourself during the recovery process. Talk to your healthcare provider about specific treatments and coping mechanisms that are most appropriate for you.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Spinal CSF Leak Foundation. Focus on causes of intracranial hypotension.

  3. Lin JP, Zhang SD, He FF, Liu MJ, Ma XX. The status of diagnosis and treatment to intracranial hypotension, including SIHJ Headache Pain. 2017;18(1):4. doi:10.1186/s10194-016-0708-8

  4. Shin HY. Recent update on epidural blood patchAnesth Pain Med. 2022;17(1):12-23. doi:10.17085/apm.21113