Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension.
OBJECTIVE
Previous reports indicate that elevated intracranial pressure (ICP) may cause spontaneous cerebrospinal fluid (CSF) leaks. In this study we examined the clinical diagnosis of benign intracranial hypertension (BIH) in this population using the modified Dandy criteria.


METHODS
We performed a retrospective review of clinical data and measurements of ICPs after surgical repair.


RESULTS
Sixteen patients with spontaneous CSF leaks were surgically treated from 1996 to 2002. In 11 patients with CSF pressure measurements, strict adherence to the modified Dandy criteria definitively confirmed a diagnosis of BIH in 8 patients (72%) and a likely diagnosis in the 3 remaining patients. The mean ICP was 31.1 cm H20 (range, 17.3 to 52 cm H2O), and 81% of the patients were obese middle-aged women. Clinically, all patients had signs and/or symptoms of elevated ICP, such as headache (91%), pulsatile tinnitus (45%), hypertension (45%), balance problems (27%), and visual complaints (18%). Surgical repair was 100% successful in leak cessation over a mean follow-up of 14.1 months.


CONCLUSIONS
Most patients with spontaneous CSF leaks fulfill the modified Dandy criteria; thus, this disorder appears to be a variant of BIH. Further investigation is needed to determine the exact cause of elevated CSF pressures in this group and whether medical or surgical treatments to correct the intracranial hypertension are warranted.
Schlosser
Rodney J
RJ
Dept of Otolaryngology-Head and Neck Surgery, 135 Rutledge Ave, Suite 1130, PO Box 250550, Medical University of South Carolina, Charleston, SC 29425, USA.
Woodworth
Bradford A
BA
Wilensky
Eileen Maloney
EM
Grady
M Sean
MS
Bolger
William E
WE
D000328:Adult; D000368:Aged; D015170:Cerebrospinal Fluid Pressure; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013129:Spinal Puncture; D014057:Tomography, X-Ray Computed