title: Spinal manifestations of spontaneous intracranial hypotension.
abstract: OBJECTIVE
  The goal of the study was to elucidate the spinal manifestations of spontaneous intracranial hypotension.
  
  
  METHODS
  The authors reviewed the medical records and imaging studies of 338 consecutive patients with spontaneous intracranial hypotension who were evaluated at their institution between 2001 and 2010.
  
  
  RESULTS
  Twenty patients (6%; mean age 35.8 [range 16 to 60 years]; 5 males and 15 females) had convincing signs or symptoms referable to the spinal cord or spinal nerve roots. The spinal manifestations consisted of radiculopathy in 11 patients (unilateral in 8 and bilateral in 3), myelopathy in 8 patients, and bibrachial amyotrophy in 1 patient. The cervical spine was involved in 12 patients, the thoracic spine in 5, and the lumbosacral spine in 3. The spinal symptoms were positional in only 3 patients. The spinal manifestations occurred around the time of the headache onset in 16 patients, and months to years after the positional headache had resolved in 4 patients. A large extrathecal CSF collection causing compression of the spinal cord or nerve root was responsible for the spinal manifestations in the majority of patients. Treatment of the spinal CSF leak resulted in resolution of the spinal manifestations along with the headache, except for those in the patient with bibrachial amyotrophy.
  
  
  CONCLUSIONS
  Spinal manifestations are uncommon in cases of spontaneous intracranial hypotension, occurring in about 6% of patients, but myelopathy and radiculopathy involving all spinal segments do occur. Unlike the headache, the spinal manifestations usually are not positional and are caused by mass effect from an extradural CSF collection.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. SchievinkW@cshs.org
authors.forename: Wouter I
authors.initials: WI
authors.lastname: Schievink
authors.forename: Ray M
authors.initials: RM
authors.lastname: Chu
authors.forename: M Marcel
authors.initials: MM
authors.lastname: Maya
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Johnson
authors.forename: Hart C M
authors.initials: HC
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging