Misdiagnosis of Spontaneous Intracranial Hypotension

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Abstract
A HEADACHE that worsens on assuming an upright position and is relieved by recumbency is a well-recognized complication of lumbar puncture.1 When the onset of such a positional headache is spontaneous, a diagnostic challenge is created even though spontaneous intracranial hypotension has been recognized for more than 6 decades, and magnetic resonance imaging has greatly facilitated the diagnosis.2-12 A spontaneous spinal cerebrospinal fluid (CSF) leak is the typical cause of spontaneous intracranial hypotension.6-12 Such spontaneous CSF leaks may result from simple dural rents or fragile arachnoid cysts, often in the presence of an underlying but previously unrecognized generalized connective tissue disorder.7,13-16 The symptoms of spontaneous intracranial hypotension may become debilitating. Effective treatment is available, and the risks of treatment for the variety of conditions that may mimic spontaneous intracranial hypotension are significant. Therefore, the importance of an expeditious correct diagnosis in these patients cannot be overemphasized. I investigated the diagnostic delay in a cohort of patients with spontaneous intracranial hypotension.

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