Diskogenic Microspurs as a Possible Cause of Intractable Spontaneous Intracranial Hypotension

With improvements in imaging, spontaneous intracranial hypotension (SIH) is frequently reported in the literature. The most common causes of SIH are arachnoid cysts, torn nerve root sleeves, meningeal diverticula, and, rarely, disc osteophytes. Historically, the first-line treatment of SIH has been medical, including keeping the patient supine and administering fluids, caffeine, and analgesia. The second-line approach calls for an epidural blood patch (EBP). Surgical treatment is reserved for cases refractory to conservative management and EBP (J Neurosurg Spine 2015; 22:478).

Investigators seeking to elucidate the nature of spinal cerebrospinal fluid (CSF) leaks in patients with intractable SIH symptoms conducted extensive imaging workups i…