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Intracranial hypotension
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== Causes == Causes of intracranial hypotension are grouped into 3 kinds of cerebrospinal fluid leaks: ''iatrogenic'', which is caused by a medical procedure; ''traumatic'', which is the result of an injury; and ''spontaneous (idiopathic)'', which is "occurring with minimal or no clear precipitant".<ref name=":2">{{Cite web | url = https://spinalcsfleak.org/about-spinal-csf-leaks/causes/ | title = Causes | date = 2016-11-20 | website = Spinal CSF Leak Foundation|language=en-US|access-date=2019-08-27}}</ref> ==== Iatrogenic causes of intracranial hypotension and spinal CSF leaks ==== * lumbar puncture (spinal tap). Spinal CSF leaks can develop after a lumbar puncture. Headaches that can develop are "often known as Post Dural Puncture Headache = PDPH. This is the most common cause of a spinal CSF leak."<ref name=":2" /> * epidural injections * spine surgery ==== Traumatic causes of intracranial hypotension and spinal CSF leaks<ref name=":2" /> ==== * brachial plexus injuries (nerves extending from the spinal cord) * spinal injuries * sports injuries * falls ==== Spontaneous (idiopathic) intracranial hypotension and spinal CSF leaks ==== Potential causes may include: "lifting small or large items, straining, stretching, positional changes, sporting activities, roller coaster rides and falls. Some of these might be categorized as traumatic. *Spontaneous spinal CSF leaks may be associated with '''spinal pathology''' such as calcified disc material or bone spurs. These leaks are usually ventral or in front of the spinal cord. *There is a growing evidence base suggesting that a significant proportion of spontaneous spinal CSF leaks occur as a result of '''preexisting weakness''' of the dura mater. A range of dural defects have been reported at surgery. Electron microscopy of dura has revealed abnormalities in a substantial proportion of cases. Heritable Disorders of Connective Tissue (HDCT) occur at a higher frequency in affected individuals; intracranial hypotension may be the first noted manifestation. Marfan syndrome, Ehlers-Danlos syndrome (both classic and hypermobility type) and Unspecified Heritable Disorders of Connective Tissue have been reported. Patients with spontaneous spinal CSF leaks have been shown to have higher risk of intracranial aneurysms, bicuspid aortic valve and thoracic aortic aneurysms and should be evaluated for HDCT. Spontaneous spinal CSF leaks are uncommon, but not rare. One estimate of annual incidence is 5 in 100,000, however this has not been well-studied. Unfortunately, misdiagnoses and delayed diagnoses are common in this subset."<ref name=":2" />
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