title: Spontaneous Intracranial Hypotension: A Review and Introduction of an Algorithm For Management.
abstract: BACKGROUND
  Spontaneous intracranial hypotension (SIH) is a condition of low cerebrospinal fluid volume and pressure caused by a leak of cerebrospinal fluid through a dural defect. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines for myelography, blood patching, and possible surgical repair. Patients should be monitored closely, because they can deteriorate into a coma or even death. There are no widely accepted guidelines for the management of SIH.
  
  
  CONCLUSIONS
  We review the existing SIH literature, illustrate management challenges via a case review, and propose an algorithm developed by neurosurgeons, radiologists, and anesthesiologists intended to simplify and streamline the management of SIH.
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: benjaminandrewdavidson@gmail.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Davidson
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Farshad
authors.initials: F
authors.lastname: Nassiri
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mansouri
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jetan H
authors.initials: JH
authors.lastname: Badhiwala
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Witiw
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Shamji
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Philip W
authors.initials: PW
authors.lastname: Peng
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Richard I
authors.initials: RI
authors.lastname: Farb
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Bernstein
mesh_terms: D000465:Algorithms; D017217:Blood Patch, Epidural / Q000379:methods; D065634:Cerebrospinal Fluid Leak / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D019468:Disease Management; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Algorithm; Blood patch; CSF leak; Myelography; Orthostatic; Spontaneous intracranial hypotension; Trendelenberg