title: Spontaneous intracranial hypotension in childhood and adolescence.
abstract: OBJECTIVE
  To describe the clinical and radiographic manifestations of spontaneous intracranial hypotension, a rarely diagnosed cause of headache in children.
  
  
  METHODS
  This study included patients 19 years of age or younger evaluated between January 1, 2001, and June 30, 2012, for spontaneous intracranial hypotension.
  
  
  RESULTS
  We evaluated 24 children (18 girls and 6 boys) with spontaneous intracranial hypotension (age at onset of symptoms: 2-19 years, mean 14.3 years). Twenty-three patients presented with orthostatic headaches and 1 presented with a nonpositional headache. A generalized connective tissue disorder was diagnosed in 54% of patients. Magnetic resonance imaging showed the typical changes of spontaneous intracranial hypotension in most patients (79%). Spinal imaging demonstrated a cerebrospinal fluid (CSF) leak with or without an associated meningeal diverticulum in 12 patients (50%) and with dural ectasia or meningeal diverticula in 10 patients (42%), and it was normal in 2 patients (8%). Twenty-three patients initially underwent epidural blood patching, but 8 patients also were treated with percutaneous injections of fibrin glue and 11 patients eventually required surgical correction of the underlying CSF leak. There was no morbidity or mortality associated with any of the treatments, but 5 patients required acetazolamide for rebound high intracranial pressure headache. Overall, outcome was good in 22 patients (92%) and poor in 2 patients (8%).
  
  
  CONCLUSIONS
  Spontaneous intracranial hypotension in childhood is rare. Most patients can be treated effectively using a combination of epidural blood patching and percutaneous injections of fibrin glue or surgical CSF leak repair in refractory cases.
authors: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. SchievinkW@cshs.org
authors: Wouter I
authors: WI
authors: Schievink
authors: M Marcel
authors: MM
authors: Maya
authors: Charles
authors: C
authors: Louy
authors: Franklin G
authors: FG
authors: Moser
authors: Liliana
authors: L
authors: Sloninsky
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000628:therapy; D008297:Male; D055815:Young Adult
keywords: CSF; CT; Cerebrospinal fluid; Computed tomography; MRI; Magnetic resonance imaging