Evaluation and management of spontaneous intracranial hypotension if repeated lumbar epidural blood patches are unsuccessful

MR: magnetic resonance; CT: computed tomography; CSF: cerebrospinal fluid.

* Refer to the UpToDate topic and algorithm on the initial management of spontaneous intracranial hypotension for details on the initial management of patients with spontaneous intracranial hypotension.

¶ Digital subtraction myelography in the lateral decubitus or prone positioning may be performed for patients with suspected CSF leak on the ventral surface of the spinal canal.

Δ Surgical repair or endovascular treatment may be applicable for some patients with a CSF leak unlikely to respond to a targeted blood patch, such as patients with intracranial hypotension due to CSF-venous fistula.