Leakage of CSF from a defect in the spinal dura mater is responsible for a pathological decrease of CSF volume ( 2– 4). The effects of the disease can be devastating and cause disability. Orthostatic headache is the hallmark of headache attributed to spontaneous intracranial hypotension (SIH) as defined by the third edition of the international classification of headache disorders (ICHD-3) category 7.2.3 ( 1). In these patients, reducing the compliance or the volume of the spinal compartment seems to be the appropriate therapeutic strategy. Thus, in rare cases, intracranial hypotension may occur in the absence of CSF leakage from the dural sac.Ĭonclusion: We propose a pathophysiological concept for the subgroup of SIH patients with typical cranial imaging findings and no evidence of CSF leakage. A combination of pathologically increased spinal compliance, decreased intracranial CSF volume, low CSF outflow resistance, and decreased venous pressure might result in a pathological orthostatic cranial-to-spinal CSF shift. Medical Hypothesis: The symptoms of SIH are caused by a decrease in intracranial CSF volume, intracranial hypotension, and downward displacement of intracranial structures. This article aims to elaborate a hypothesis that would explain a pathologically increased orthostatic shift of CSF from the cranial to the spinal compartment in the absence of a CSF leak. However, some patients present with classic orthostatic symptoms and typical intracranial imaging findings without evidence of CSF leakage despite repeated diagnostic work-up. Objective: Spontaneous intracranial hypotension (SIH) is typically caused by CSF leakage from a spinal dural tear, a meningeal diverticulum, or a CSF venous fistula. 3Department of Neurosurgery, Freiburg University Hospital, Freiburg, Germany.2University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.Piechowiak 2, Jan Gralla 2, Tomas Dobrocky 2, Jürgen Beck 3 and Andreas Raabe 1 * Johannes Goldberg 1 †, Levin Häni 1 †, Christopher Marvin Jesse 1, Irena Zubak 1, Eike I.

Spontaneous cerebrospinal fluid leak