Review the diagnostic approach of Intracranial Hypotension (HI) by fistula of cerebrospinal fluid (CSF), taking into account the imaging findings and evaluate different treatment options, according to each clinical case.

Persistent headache by IH is a syndrome with serious neurological sequelae. It is an important cause of headache in young and middle aged individuals but it is often misdiagnosis. We retrospectively reviewed data, medical history and imaging of five patients in our hospital, 3 men and 2 women, age range between 27 and 54 years, who were admitted for suspected intracranial hypotension by licuoral fistula between May 2007 and September 2011. All patients underwent, initial cranial CT without intravenous contrast enhancement (GE 64-detector rows) by...

All the patients had persistent orthostatic headache, which did not improved with conventional analgesic treatment, with nausea and vomiting, without any other symptoms or neurological signs on physical examination. Two patients didn´t have any pathologies in their medical history. One patient suffered a severe head injury in childhood, that required surgery by multiple brain hematomas, another patient had undergone lumbar puncture in last two weeks, but his headache had started before to the puncture and the last patient had a history of the epidural anesthesia...

Postural orthostatic headache is the most common symptom of HI and although this disease occurs more frequently after a lumbar puncture, there is also a type of spontaneous onset, caused by CSF leak, which has even come to associate with minimum prior trauma. Physical examination of these patients is usually normal and imaging studies are made by persistence of headache despite conventional treatment in the emergency room, as in the case of our patients. The initial study usually is cranial CT, which rules out other...

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