Cerebrospinal fluid leak - Knowledge (XXG)

624: 539:, either from a spinal disc herniation, osteophyte or microspur on the disc or vertebral body. "Recent radiological and microsurgical investigations revealed that a calcified, degenerative bony microspur is often the culprit lesion in cases of intractable CSF leaks. Arising from the level of the intervertebrate disk space, these microspurs pierce the ventral dura and produce a slit-like defect a few millimeters in length. These microspurs and the associated CSF leak have to be localized exactly, and then they are amenable to surgical treatment." 93: 1022: 65: 786:, and assays are the most common types of CSF leak instrumental tests. Many CSF leaks do not show up on imaging and chemical assays, thus such diagnostic tools are not definitive to rule out CSF leaks. A clinician may often depend upon patient history and exam to diagnose, for example: discharge of excessive amount of clear fluid from the nose upon bending over, the increase in headache following a 51: 943: 404:. This headache is usually made worse by standing and typically becomes prominent throughout the day, with the pain becoming less severe when lying down. Orthostatic headaches can become chronic and disabling to the point of incapacitation. Some people will develop headaches that begin in the afternoon. This is known as 199:, which worsen when standing, and improve when lying down. Other symptoms can include neck pain or stiffness, nausea, vomiting, dizziness, fatigue, and a metallic taste in the mouth. A CT myelography scan can identify the site of a cerebrospinal fluid leakage. Once identified, the leak can often be repaired by an 1145:

Spontaneous CSF leaks have been described by notable physicians and reported in medical journals dating back to the early 1900s. German neurologist Georg Schaltenbrand reported in 1938 and 1953 what he termed "aliquorrhea", a condition marked by very low, unobtainable, or even negative CSF pressures.

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has been used. This procedure is believed to decrease spinal CSF volume while increasing intracranial CSF pressure and volume. This procedure restores normal intracranial CSF volume and pressure while promoting the healing of dural tears by lowering the pressure and volume in the dura. This procedure

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A clinical exam is often used as a means to diagnose CSF leaks. Improved patient response to conservative treatment may further define a positive diagnosis. The lack of clinician awareness of the signs -symptoms and ailments- of a CSF leak is the greatest challenge to proper diagnosis and treatment,

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Spontaneous intracranial hypotension (SIH) is an important cause of longstanding headaches. Other symptoms can include nausea, blurred vision, coma, and dementia. SIH is typically secondary to a spontaneous spinal CSF leak. Cranial CSF leaks do not cause SIH. While this symptom can be referred to as

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In three small studies of 1-2 patients with recurrent CSF leaks where repeated blood patches failed to form clots and relieve symptoms, the patients received temporary but complete resolution of symptoms with an epidural saline infusion. The saline infusion temporarily restores the volume necessary

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wrote about "headaches associated with decreased intracranial pressure". The full clinical manifestations of intracranial hypotension and CSF leaks were described in several publications reported between the 1960s and early 1990s. Modern reports of spontaneous CSF leak have been reported to medical

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The treatment of choice for this condition is the surgical application of epidural blood patches, which has a higher success rate than conservative treatments of bed rest and hydration. Through the injection of a person's own blood into the area of the hole in the dura, an epidural blood patch uses

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Some studies have proposed that issues with the spinal venous drainage system may cause a CSF leak. According to this theory, dural holes and intracranial hypotension are symptoms caused by low venous pressure in the epidural space. When leg muscles pump blood towards the heart, and pressure in the

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People with cranial CSF leaks, the rarer form, have a 10% risk of developing meningitis per year. If cranial leaks last more than seven days, the chances of developing meningitis are significantly higher. Spinal CSF leaks cannot result in meningitis due to the sterile conditions of the leak site.

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and number of patch attempts for patients is highly variable. One-quarter to one-third of those with a sCSFL patients do not have relief of symptoms from epidural blood patching. Finding the location of a cerebrospinal fluid leak is not required prior to using an epidural blood patch as initial

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For patients with recalcitrant spontaneous intracranial hypotension and no leak found on conventional spinal imaging, digital subtraction myelography, CT myelography and dynamic myelography (a modified conventional myelography technique) should be considered to rule out a CSF-venous fistula. In

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of the brain and contained by the dura and arachnoid layers of the meninges. The brain floats in CSF, which also transports nutrients to the brain and spinal cord. As holes form in the spinal dura mater, CSF leaks out into the surrounding space. The CSF is then absorbed into the spinal epidural

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A spontaneous CSF leak is a rare condition, affecting at least one in 20,000 people and many more who go undiagnosed every year. On average, the condition develops at age 42, and women are twice as likely to be affected. Some people with a sCSF leak have a chronic leak despite repeated patching

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Long-term outcomes for people with sCSFLS remain poorly studied. Symptoms may resolve in as little as two weeks, or persist for months. Less commonly, patients may have unremitting symptoms for many years. People with chronic sCSFLS may be disabled and unable to work. Recurrent CSF leak at an

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Studies have shown that sCSF leaks runs in families. It is suspected that genetic similarity in families includes weakness in the dura mater which leads to a sCSFL. Large scale population-based studies have not yet been conducted. While a majority of sCSF leaks continue to be undiagnosed or

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vein becomes negative, the network of epidural veins is overdrained, causing CSF to be aspirated into the epidural space. True leaks can form at weak points in the spinal meninges. Therefore, the observed CSF hypotension is a result of CSF hypovolemia and reduced epidural venous pressure.

880:, and other abnormalities. For 20% of patients, MRIs present as completely normal. MRIs performed with the patient seated upright (vs. laying supine) are not better for diagnosing CSF leaks, but are more than twice as effective at diagnosing cerebellar tonsillar ectopia, also known as 895:. This has been effective in identifying the sites of a CSF leak without the need for a CT scan, lumbar puncture, and contrast and at locating fluid collections such as CSF pooling. Another highly successful method of locating a CSF leak is intrathecal contrast and MR Myelography. 1146:

The symptoms included orthostatic headaches and other features that are now recognized as spontaneous intracranial hypotension. A few decades earlier, the same syndrome had been described in French literature as "hypotension of spinal fluid" and "ventricular collapse". In 1940,

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Franzini, A.; Messina, G.; Nazzi, V.; Mea, E.; Leone, M.; Chiapparini, L.; Broggi, G.; Bussone, G. (2009). "Spontaneous intracranial hypotension syndrome: a novel speculative physiopathological hypothesis and a novel patch method in a series of 28 consecutive patients".

608:, where the root sleeve is absent, are at increased risk for developing recurrent CSF leaks. Lumbar disc herniation has been reported to cause CSF leaks in at least one case. Degenerative spinal disc diseases cause a disc to pierce the dura mater, leading to a CSF leak. 4821:

Wang, Timothy Y.; Karikari, Isaac O.; Amrhein, Timothy J.; Gray, Linda; Kranz, Peter G. (2020-03-01). "Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series".

408:. This may be an initial presentation of a spontaneous CSF leak or appear after treatment such as an epidural patch, and likely indicates a slow spinal CSF leak. While high CSF pressure can make lying down unbearable, low CSF pressure due to a leak can be relieved by 638:

Several complications can occur as a result of sCSFLS including decreased cranial pressure, brain herniation, infection, blood pressure problems, transient paralysis, and coma. The primary and most serious complication of a spontaneous cerebrospinal fluid leak is

1133:-based study indicated five per 100,000. sCSF leaks generally affect the young and middle aged; the average age for onset is 42.3 years, but onset can range from ages 22 to 61. In an 11-year study, women were found to be twice as likely to be affected as men. 234:

Cerebrospinal fluid leaks are classified into two distinct disorders: cranial leaks, and spinal leaks. Where there has been no preceding surgery or medical procedure that may have caused a CSF leak it is called a spontaneous CSF leak (sCSF leak).

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Kranz, Peter G.; Luetmer, Patrick H.; Diehn, Felix E.; Amrhein, Timothy J.; Tanpitukpongse, Teerath Peter; Gray, Linda (2015-12-23). "Myelographic Techniques for the Detection of Spinal CSF Leaks in Spontaneous Intracranial Hypotension".

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Freeman, MD; Rosa, S; Harshfield, D; Smith, F; Bennett, R; Centeno, C. J.; Kornel, E; Nystrom, A; Heffez, D; Kohles, S. S. (2010). "A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash)".

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A spontaneous spinal CSF leak refers to any CSF leak that has not been preceded by a surgical or other medical procedure. Later evidence suggests that these leaks result from either a discogenic pathology, such as microspur,

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in particular: the loss of the orthostatic characteristic of headache and that every chronic CSF leaker will have a unique symptom set that as a whole contributes to the underlying condition, and diagnosis of, a CSF leak.

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Ferrante, E.; Arpino, I.; Citterio, A.; Savino, A. (2009). "Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in the Trendelenburg position pre-medicated with acetazolamide".

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Syre, P; Bohman, LE; Baltuch, G; Le Roux, P; Welch, WC (15 July 2014). "Cerebrospinal fluid leaks and their management after anterior cervical discectomy and fusion: a report of 13 cases and a review of the literature".

958:. However, patients with confirmed CSF leaks may also demonstrate completely normal opening pressures. In 18–46% of cases, the CSF pressure is measured within the normal range. Analysis of spinal fluid may demonstrate 4559:

Grimaldi, D.; Mea, E.; Chiapparini, L.; Ciceri, E.; Nappini, S.; Savoiardo, M.; Castelli, M.; Cortelli, P.; Carriero, M. R.; Leone, M.; Bussone, G. (2004). "Spontaneous low cerebrospinal pressure: a mini review".

1007:, which increases intracranial pressure by compressing the abdomen, can temporarily relieve symptoms for some people. Sometimes a CSF leak will heal on its own. Otherwise, symptoms may last months or even years. 255:

The vast majority of CSF leaks are spinal. Spinal leaks occur when one or more holes form in the dura along the spinal cord. There are three types of spontaneous spinal CSF leaks. A spinal leak typically causes

6014: 678:; however when the CSF leak is repaired the tonsil position often returns to normal (as seen in upright MRI) in this "pseudo-Chiari" condition. A further, albeit rare, complication of CSF leak is transient 465:

Aural symptoms are also present in many cases of intracranial hypotension due to CSF leak; including muffled hearing, pulsatile tinnitus, hearing loss. Less common symptoms include double vision (due to

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Schrijver, I.; Schievink, W. I.; Godfrey, M.; Meyer, F. B.; Francke, U. (2002). "Spontaneous spinal cerebrospinal fluid leaks and minor skeletal features of Marfan syndrome: a microfibrillopathy".

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Mea, E.; Chiapparini, L.; Savoiardo, M.; Franzini, A.; Bussone, G.; Leone, M. (2009). "Clinical features and outcomes in spontaneous intracranial hypotension: a survey of 90 consecutive patients".

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Binder, DK; Dillon, WP; Fishman, RA; Schmidt, MH (2002). "Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report".

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Clark, Michael S.; Diehn, Felix E.; Verdoorn, Jared T.; Lehman, Vance T.; Liebo, Greta B.; Morris, Jonathan M.; Thielen, Kent R.; Wald, John T.; Kumar, Neeraj; Luetmer, Patrick H. (January 2018).

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Schievink, W.; Palestrant, D.; Maya, M.; Rappard, G. (2009). "Spontaneous spinal cerebrospinal fluid leak as a cause of coma after craniotomy for clipping of an unruptured intracranial aneurysm".

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are the three most common connective tissue disorders associated with sCSFLs. Roughly 20% of patients with a sCSFL exhibit features of Marfan syndrome, including tall stature, hollowed chest (

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Some cases of chronic intracranial hypotension due to CSF leak may present as personality changes, altered behaviors and impairment of executive functions, similar to behavioral-variant

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Kranz, Peter G.; Amrhein, Timothy J.; Gray, Linda (December 2017). "CSF Venous Fistulas in Spontaneous Intracranial Hypotension: Imaging Characteristics on Dynamic and CT Myelography".

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attempts, leading to long-term disability due to pain and being unable to be upright, and surgery is often needed. The symptoms of a spontaneous CSF leak were first described by German

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is less effective than CT at directly imaging sites of CSF leak. MRI studies may show pachymeningeal enhancement (when the dura mater looks thick and inflamed), sagging of the brain,

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Schievink, W. I.; Morreale, V. M.; Atkinson, J. L. D.; Meyer, F. B.; Piepgras, D. G.; Ebersold, M. J. (1998). "Surgical treatment of spontaneous spinal cerebrospinal fluid leaks".

527:. One study suggested a CSF leak to follow from 0.5% of operations. Another study suggests a CSF leak to follow from 1% of operations. In most of these cases repair is successful. 1193:. A study of people with a sCSF leak demonstrated no mutations in this gene. Minor features of Marfan syndrome have been found in 20% of CSF leak patients. Abnormal findings of 5031:

Schievink, W.; Maya, M.; Pikul, B.; Louy, C. (2009). "Spontaneous spinal cerebrospinal fluid leaks as the cause of subdural hematomas in elderly patients on anticoagulation".

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Rouaud, T.; Lallement, F.; Choui, R.; Madigand, M. (2009). "Traitement de l'hypotension spontanée du liquide cérébrospinal par perfusion épidurale de sérum salé isotonique".

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and fibrin glue. Primary suturing is rarely able to repair a CSF leak, and in some patients exploration of the dura may be required to properly locate all sites of CSF leak.

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Wang, Y. -F.; Lirng, J. -F.; Fuh, J. -L.; Hseu, S. -S.; Wang, S. -J. (2009). "Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension".

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for a patient to avoid SIH until the leak can be repaired properly. Intrathecal saline infusion is used in urgent cases such as intractable pain or decreased consciousness.

813:. The average time from onset of symptoms until definitive diagnosis is 13 months. A 2007 study found a 0% success rate for proper diagnosis in the emergency department. 828: 797:

The primary place of first complaint to a physician is a hospital emergency room. Up to 94% of those with sCSFLS are initially misdiagnosed. Incorrect diagnoses include

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Kranz, Peter G.; Gray, Linda; Malinzak, Michael D.; Amrhein, Timothy J. (2019-11-01). "Spontaneous Intracranial Hypotension: Pathogenesis, Diagnosis, and Treatment".

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in the vast majority of cases. The increased pressure causes a rupture of the cranial dura mater, leading to a CSF leak and intracranial hypotension. Patients with a

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complexes, thereby causing a variety of sensory symptoms. Nerves that can be affected and their related symptoms are detailed in the table at right. A rare form of

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Schievink, W. I.; Maya, M. M.; Riedinger, M. (2003). "Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study".

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Alonso Cánovas, A; Martínez San Millán, J; Novillo López, ME; Masjuán Vallejo, J (2008). "Third cranial nerve palsy due to intracranial hypotension syndrome".

1735:"Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome: A Systematic Review and Meta-analysis" 1166:

is a corticosteroid that causes the brain to produce additional spinal fluid to replace the volume of the lost CSF and alleviate symptoms, and has been given

5556: 563: 3483: 966:. This is hypothesized to be due to increased permeability of dilated meningeal blood vessels and a decrease of CSF flow in the lumbar subarachnoid space. 4734:

Kitchel, SH; Eismont, FJ; Green, BA (1989). "Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine".

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Schievink, W. I.; Maya, M. M.; Moser, F. M. (2004). "Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant".

4683: 4681: 4679: 4677: 4675: 4420:"Prevalence of hyperdense paraspinal vein sign in patients with spontaneous intracranial hypotension without dural CSF leak on standard CT myelography" 503:. Symptoms often include a watery discharge including CSF from one side of the nose, or from the ear. There may also be a metallic taste in the mouth. 6491: 6382: 846:

is injected into the spinal fluid. The contrast then diffuses out through the dura sac before leaking through dural holes. This allows for a CTM with

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Mokri, B. (1999). "Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia--evolution of a concept".

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Schievink, WI; Jacques, L (2003). "Recurrent spontaneous spinal cerebrospinal fluid leak associated with "nude nerve root" syndrome: case report".

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A cerebrospinal fluid leak can be either cranial or spinal, and these are two different disorders. A spinal CSF leak can be caused by one or more

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Schievink, W. I. (2009). "A Novel Technique for Treatment of Intractable Spontaneous Intracranial Hypotension: Lumbar Dural Reduction Surgery".

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Stenzel, M.; Preuss, S.; Orloff, L.; Jecker, P.; Mann, W. (2005). "Cerebrospinal Fluid Leaks of Temporal Bone Origin: Etiology and Management".

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Surgery to treat a CSF-venous fistula in CSF leak patients is highly effective. Neurosurgery is available to directly repair leaking meningeal

4729: 4727: 276:, the intracranial pressure may be normal, with the underlying issue instead being low CSF volume, in this case a sCSFL may be referred to as 6377: 6009: 4346: 3892: 2488: 2065: 2031: 520:

that pierces the dura like a knife, connective tissue disorder (which can often lead to discogenic pathology), or spinal drainage problems.

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Ferrante, E.; Wetzl, R.; Savino, A.; Citterio, A.; Protti, A. (2004). "Spontaneous cerebrospinal fluid leak syndrome: report of 18 cases".

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Movement disorders are uncommon in spontaneous CSF leaks but occasionally can be one of the major components of the clinical presentation.

257: 884:. Cerebellar tonsillar ectopia shares many of the same symptoms as CSF leak, but originates either congenitally or from trauma, including 2021: 1197:

have been documented in these CSF leak patients, but only one patient demonstrated a fibrillin-1 defect consistent with Marfan syndrome.

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addition, presence of a hyperdense paraspinal vein should be investigated in imaging as it is highly suggestive of a CSF venous fistula.

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Schlosser, RJ; Wilensky, EM; Grady, MS; Bolger, WE (2003). "Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks".

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or soft tissues around the spine. Due to the sterile conditions of the soft tissues around the spine, there is no risk of meningitis.

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Chan, SM; Chodakiewitz, YG; Maya, MM; Schievink, WI; Moser, FG (May 2019). "Intracranial Hypotension and Cerebrospinal Fluid Leak".

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Dobrocky, T; Nicholson, P; Häni, L; et al. (April 2022). "Spontaneous intracranial hypotension: searching for the CSF leak".

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Spontaneous intracranial hypotension (SIH) refers to lower than normal CSF volume due to a leak of CSF at the level of the spine.

3959: 3455: 6256: 927: 822: 705:. Coma due to a CSF leak has been successfully treated by using blood patches and/or fibrin glue and placing the person in the 627: 134:), or nonspontaneous (secondary) where it is attributed to an underlying condition. Causes of a primary CSF leak are those of 5771: 5747: 5577: 5963: 838:(CTM) scan of the spinal column for fluid leaks. The opening fluid pressure in the spinal canal is obtained by performing a 6450: 6335: 6251: 6193: 5742: 2811:

Schievink, W. I.; Louy, C. (2007). "Precipitating Factors of Spontaneous Spinal Csf Leaks and Intracranial Hypotension".

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Schievink, W. I.; Maya, M. M. (2006). "Quadriplegia and cerebellar hemorrhage in spontaneous intracranial hypotension".

694:, where the ability to move one's eyes becomes difficult and interrupted due to compression of the third cranial nerve. 551:

affecting the spinal dura. It may also run in families and be associated with aortic aneurysms and joint hypermobility.

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Tam, EK; Gilbert, AL (November 2019). "Spontaneous cerebrospinal fluid leak and idiopathic intracranial hypertension".

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Mokri, B. (2007). "Familial Occurrence of Spontaneous Spinal CSF Leaks: Underlying Connective Tissue Disorder (CME)".

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Cranial leaks occur in the head, and in some of these cases, CSF can leak from one side of the nose, or from the ear.

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Canas, N; Medeiros, E; Fonseca, AT; Palma-Mira, F (2004). "CSF volume loss in spontaneous intracranial hypotension".

1519:"Connective tissue spectrum abnormalities associated with spontaneous cerebrospinal fluid leaks: a prospective study" 559: 4249:

Kelley, G (2004). "CSF hypovolemia vs intracranial hypotension in "spontaneous intracranial hypotension syndrome"".

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Lloyd, K. M.; Delgaudio, J. M.; Hudgins, P. A. (2008). "Imaging of Skull Base Cerebrospinal Fluid Leaks in Adults".

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and then a metal clip can be placed in order to hold the ligation closed. Alternatively, a small compress called a

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Rupp, S. M.; Wilson, C. B. (1989). "Treatment of spontaneous cerebrospinal fluid leak with epidural blood patch".

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lumbar epidural blood patches often provide relief of symptoms and resolve the leak without further intervention.

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and causes major compression of the upper cervical spinal cord. The quadriplegia dissipates once the patient lies

6357: 6325: 6277: 6126: 5705: 5250:"Use of intravenous tetracosactin in the treatment of postdural puncture headache: our experience in forty cases" 601: 244: 1733:

D'Antona, L; Jaime Merchan, MA; Vassiliou, A; Watkins, LD; Davagnanam, I; Toma, AK; Matharu, MS (1 March 2021).

6486: 6424: 6198: 5612: 5500: 2895:"Intradural non-calcified thoracic disc herniation causing spontaneous intracranial hypotension: a case report" 1190: 1055:

can be used in place of blood patching, raising the effectiveness of forming a clot and arresting CSF leakage.

643:, where pressure in the brain is severely decreased. This complication leads to the hallmark symptom of severe 6429: 6362: 6118: 5936: 5788: 5778: 5622: 959: 698: 656: 477: 365: 4767: 4765: 480:

as the frontal and temporal lobes are affected by downward sagging due to reduced intra-cranial pressures.

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Mokri, Bahram (December 2014). "Movement disorders associated with spontaneous CSF leaks: a case series".

1109: 706: 691: 571: 517: 384: 188:. A loss of CSF greater than its rate of production leads to a decreased volume inside the skull known as 147: 176:. A spontaneous spinal cerebrospinal fluid leak may occur sometimes in those with predisposing heritable 6309: 6183: 6001: 5979: 5894: 5817: 5727: 5714: 5639: 2381:"Repeated large-volume epidural blood patches for the treatment of spontaneous intracranial hypotension" 1105: 750:, at the base of the skull. The lower portion of the brain is believed to stretch or impact one or more 660: 640: 467: 189: 5093:

Schaltenbrand, G (1953). "Normal and pathological physiology of the cerebrospinal fluid circulation".

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Larrosa, D; Vázquez, J; Mateo, I; Infante, J (2009). "Familial spontaneous intracranial hypotension".

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Schievink, W. I. (2006). "Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension".

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A 1994 community-based study indicated that two out of every 100,000 people with a sCSF, while a 2004

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to locate and image any sites of dura rupture via contrast seen outside the dura sac in the imagery.

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Up to two thirds of those affected demonstrate some type of generalized connective tissue disorder.

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Schievink, W. I.; Moser, F. G.; Pikul, B. K. (2007). "Reversal of coma with an injection of glue".

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Patients with CSF leaks have been noted to have very low or even negative opening pressures during

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when blood pressure drops significantly. The autonomic dysfunction is caused by compression of the

215: 115: 4371:"Digital subtraction myelography for the identification of spontaneous spinal CSF-venous fistulas" 3416:"Caffeine, is it effective for prevention of postdural puncture headache in young adult patients?" 6345: 6330: 6318: 6068: 6019: 5856: 5719: 5607: 5357: 5279: 5013: 4974: 4803: 4713: 4585: 4500: 4317: 4274: 4166: 4123: 4076: 3863: 3820: 3708: 3648: 3600: 3525: 3437: 3345: 3302: 3259: 3213: 3166: 3123: 3021: 2836: 2769: 2718: 2666: 2620: 2533: 2448: 2269: 2002: 1959: 1813: 1712: 1637: 1499: 1397: 931: 726: 588: 5541: 547:

Various scientists and physicians have suggested that sCSFLs may be the result of an underlying

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or the reduction of headache when the patient takes a prone position are positive indicators.

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Michael Schuenke; Udo Schumacher; Erik Schulte; Edward D. Lamperti; Lawrence M. Ross (2007).

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Liu, F. -C.; Fuh, J. -L.; Wang, Y. -F.; Wang, S. -J. (2011). "Connective tissue disorders in

2859:"Diagnostic challenges and therapeutic possibilities in spontaneous intracranial hypotension" 247:

is often associated with a spontaneous cranial CSF leak, rarely reported with a spinal leak.

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If blood patches alone do not succeed in closing the dural tears, placement of percutaneous

1035: 1004: 873: 683: 567: 443: 4867:"Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures" 6153: 5844: 4475:

Schievink, W. I.; Deline, C. R. (2014). "Headache secondary to intracranial hypotension".

4047:"Upright MRI in Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension" 1182: 1064: 955: 947: 934:

which would be highly accurate in identifying CS fluid and diagnosing a cranial CSF leak.

839: 687: 612: 575: 555: 409: 181: 151: 4227: 2946:"Complications of anterior cervical spine surgery: a systematic review of the literature" 2473: 1299: 4891: 4866: 4369:

Schievink, Wouter I.; Moser, Franklin G.; Maya, M. Marcel; Prasad, Ravi S. (June 2016).

1911: 1886: 6210: 6159: 5987: 5696: 5573: 4452: 4419: 4305: 3981: 3954: 3696: 3391: 3364: 3333: 2972: 2945: 2921: 2894: 2824: 2316: 2291: 1857: 1832: 1759: 1734: 1543: 1518: 1342: 1276: 1249: 1211: 1163: 1130: 1000: 747: 743: 722: 488: 331: 173: 64: 5106: 4621: 4604: 4184:

O'Cearbhaill, Roisin M.; Kavanagh, Eoin C. (March 2018). "Beta-2 Transferrin and IR".

3851: 1947: 27:

Leakage of fluid surrounding the brain and spinal cord through tears in the dura mater

6475: 6236: 6188: 6058: 5827: 5783: 5634: 5345: 5266: 5249: 5225: 5208: 4790: 4773: 4747: 4701: 4063: 4046: 3217: 3154: 2787: 2722: 2257: 1963: 1716: 1624: 1607: 1503: 1147: 963: 751: 731: 652: 487:

or death as late stage findings as the brainstem herniates through the skull base or

219: 5283: 5017: 4717: 4504: 4321: 4278: 4170: 4080: 3712: 3652: 3604: 3529: 3441: 3349: 3306: 3263: 3170: 3127: 3025: 2840: 2670: 2641:

Hofmann, E.; Behr, R.; Schwager, K. (2009). "Imaging of cerebrospinal fluid leaks".

2624: 2537: 2452: 2273: 2006: 1817: 1641: 1021: 5732: 5602: 5585: 5361: 4978: 4882: 4807: 4589: 4127: 3867: 3824: 3808: 2773: 2471:

Victor, Maurice; Ropper, Allan H.; Adams, Raymond Delacy; Brown, Robert F. (2005).

1833:"Spontaneous Spinal CSF Leaks Stratified by Age, Body Mass Index, and Spinal Level" 1401: 1089: 1077: 898:

Contrast-enhanced brain MRI with sagittal reformats can assess for the following:

742:

Lack of CSF pressure and volume can allow the brain to sag and descend through the

713:, a bony structure that surround the pituitary gland, occurs in CSF leak patients. 679: 348: 165: 135: 5133:"Cerebrospinal fluid volume depletion and its emerging clinical/imaging syndromes" 1236: 5505: 5310: 4154: 4111: 3928: 3915:

Inamasu, J.; Guiot, B. (2006). "Intracranial hypotension with spinal pathology".

3882: 3548:

Abuabara, A (2007). "Cerebrospinal fluid rhinorrhoea: diagnosis and management".

3247: 3234:

Woodworth, B. A.; Palmer, J. N. (2009). "Spontaneous cerebrospinal fluid leaks".

3009: 1750: 1700: 762:

may be caused by a sagging brain, a characteristic of intracranial hypotension.

5691: 5652: 5594: 5524: 5209:"Use of intravenous cosyntropin in the treatment of postdural puncture headache" 4657: 4022: 4005: 2693:

Schievink, Wouter I. (2 December 2021). "Spontaneous Intracranial Hypotension".

2504:

Leep Hunderfund, A. N.; Mokri, B. (2011). "Second-half-of-the-day headache as a

1231: 1194: 1151: 1101: 1052: 996: 864:

There is disagreement over whether MRI should be the diagnostic tool of choice.

847: 431: 400:

The most common symptom of a spinal CSF leak is a fast-onset, extremely painful

312: 223: 212: 204: 130:. A CSF leak is classed as either spontaneous (primary), having no known cause ( 123: 5388: 5185: 4962: 4927: 4387: 4370: 4197: 3955:"Frequency of spontaneous intracranial hypotension in the emergency department" 3669: 3432: 3415: 3290: 1902: 655:, surgery becomes necessary in order to prevent infection and repair the leak. 5802: 5672: 5482: 5478: 5001: 4573: 4536: 4519: 4488: 3972: 3771: 3755:"Intracranial hypotension causing reversible frontotemporal dementia and coma" 3754: 3636: 3513: 3382: 2911: 2654: 2608: 2521: 2436: 2397: 2380: 1990: 1579: 1479: 1248:

Tai, YC; Tai, YS; Ou, CH; Lui, CC; Wang, HK; Kuo, HC; Hsu, SP (2 March 2022).

1068:

has led to positive results leading to relief of symptoms for up to one year.

984: 918:

For suspected spinal CSF leaks, spine imaging can be used to guide treatment.

827:

Diagnosis of a cerebrospinal fluid leak is performed through a combination of

802: 536: 513: 143: 127: 50: 5044: 4843: 4443: 4396: 4205: 3111: 3069: 2875: 2858: 2757: 2749: 1517:

Reinstein, E; Pariani, M; Bannykh, S; Rimoin, D; Schievink, WI (April 2013).

1487: 1439: 1385: 1266: 1029:

and injected in the epidural space in order to close holes in the dura mater.

770:

Diagnosis of CSF leakage can be done by various imaging techniques, chemical

634:

have descended, and should be considered in differential diagnosis of sCSFLS.

5912: 5863: 5851: 5834: 5766: 3201: 2962: 2788:"Headache Secondary to Intracranial Hypotension, Schievink, W and Deline, C" 2352: 2307: 1304: 942: 869: 835: 664: 459: 455: 435: 416: 341: 86: 5396: 5353: 5318: 5275: 5234: 5158: 5149: 5132: 5114: 5079: 5052: 5009: 4935: 4900: 4851: 4799: 4709: 4665: 4630: 4581: 4545: 4520:"Spontaneous C1-2 CSF leak treated with high cervical epidural blood patch" 4496: 4461: 4435: 4404: 4313: 4270: 4213: 4162: 4119: 4072: 4031: 3990: 3936: 3859: 3816: 3780: 3739: 3704: 3644: 3596: 3561: 3521: 3400: 3341: 3298: 3255: 3209: 3162: 3119: 3077: 3017: 2981: 2930: 2832: 2765: 2714: 2662: 2616: 2529: 2444: 2406: 2360: 2325: 2265: 2169: 2160: 2143: 2109: 1998: 1955: 1920: 1866: 1809: 1784:"Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks" 1768: 1708: 1633: 1587: 1552: 1495: 1447: 1393: 1325: 1285: 150:

as a cause can give the sign of CSF leakage from the ear, nose or mouth. A

5193: 4970: 4755: 4262: 3953:

Schievink, W. I.; Maya, M. M.; Moser, F.; Tourje, J.; Torbati, S. (2007).

3365:"Spontaneous Intracranial Hypotension Secondary to Lumbar Disc Herniation" 2706: 1534: 1085: 987:

for both cranial and spinal CSF leaks. Initial measures can include rest,

6092: 6084: 6050: 5904: 5807: 4835: 4774:"The paradox of intracranial hypotension responding well to CSF drainage" 2244:

Schievink, W. I. (2008). "Spontaneous spinal cerebrospinal fluid leaks".

1431: 1377: 988: 798: 755: 447: 424: 162: 139: 73: 5438: 4605:"Spontaneous Intracranial Hypotension Treated by Epidural Blood Patches" 3623:

Schwedt, TJ; Dodick, DW (2007). "Spontaneous intracranial hypotension".

2292:"Spontaneous intracranial hypotension: a cause of severe acute headache" 930:) or ears (CSF otorrhea) should be collected and tested for the protein 2101: 1848: 1800: 1783: 779: 169: 142:

or intentional injury, or arising from a medical intervention known as

3588: 6131: 5872: 5839: 5473: 5450: 5423: 1181:

has been implicated in several connective tissue disorders including

1178: 992: 451: 420: 203:, an injection of the patient's own blood at the site of the leak, a 6387:

Spinal muscular atrophy with lower extremity predominance (SMALED)

4865:

Ratilal, BO; Costa, J; Pappamikail, L; Sampaio, C (28 April 2015).

3577:

ORL; Journal for Oto-Rhino-Laryngology and Its Related Specialties

1080:. The areas of dura leak can be tied together in a process called 1020: 941: 771: 682:

due to a sudden and significant loss of CSF. This loss results in

622: 500: 119: 2595:

Spears, R. C. (2014). "Low-pressure/spinal fluid leak headache".

891:

An alternate method of locating the site of a CSF leak is to use

702: 484: 5545: 4772:

Roosendaal, C. M.; Coppes, M. H.; Vroomen, P. C. A. J. (2009).

2290:

Vaidhyanath, R.; Kenningham, R.; Khan, A.; Messios, N. (2007).

842:, also known as a spinal tap. Once the pressure is measured, a 5248:

Cánovas, L; Barros, C; Gómez, A; Castro, M; Castro, A (2002).

3753:

Sayao, AL; Heran, MK; Chapman, K; Redekop, G; Foti, D (2009).

892: 783: 3236:

Current Opinion in Otolaryngology & Head and Neck Surgery

578:. However, no other Marfan syndrome presentations are shown. 5418: 1137:

misdiagnosed, an actual increase in occurrence is unlikely.

523:

A cerebrospinal fluid leak can be a rare complication of an

4228:"CSF Otorrhea: Practice Essentials, Epidemiology, Etiology" 3456:"Iatrogenic CSF Leaks from Lumbar Punctures – a commentary" 1663:"CSF leak (Cerebrospinal fluid leak) - Symptoms and causes" 3470:"Cerebrospinal Fluid (CSF) Leak: Symptoms & Treatment" 3670:"Spontaneous Spinal Cerebrospinal Fluid Leaks: Diagnosis" 3500:

Mokri, B (2001). "Spontaneous intracranial hypotension".

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Diagnostic and Interventional Radiology (Ankara, Turkey)

2479:. New York: McGraw-Hill Medical Pub. Division. pp. 2144:"Spontaneous spinal cerebrospinal fluid leaks: a review" 2026:. New York, NY: Thieme Medical Publishers. p. 178. 1831:

Mamlouk, MD; Shen, PY; Jun, P; Sedrak, MF (July 2022).

1470:. Minimally Invasive Image-Guided Spine Interventions. 4736:

The Journal of Bone and Joint Surgery. American Volume

4006:"Misdiagnosis of Spontaneous Intracranial Hypotension" 3229: 3227: 2466: 2464: 2462: 1088:

can be placed over the dura leak and then sealed with

2060:. Lippincott Williams & Wilkins. pp. 1303–. 1063:

In extreme cases of intractable CSF leak, a surgical

535:

The most common cause of an intractable sCSF leak is

5428: 6308: 6285: 6276: 6269: 6224: 6174: 6146: 6117: 6083: 6045: 6034: 6000: 5978: 5903: 5713: 5704: 5690: 5650: 5593: 5584: 5515: 5432: 1003:may provide transient relief for some patients. An 774:of bodily fluid discharged from a head orifice, or 80: 40: 35: 415:About 50% of people with a spinal CSFL experience 76:of the central nervous system impacted by CSF leak 3948: 3946: 2738:Cephalalgia: An International Journal of Headache 2688: 2686: 2684: 2682: 2680: 2246:Cephalalgia: An International Journal of Headache 2239: 2237: 2235: 2233: 2231: 2229: 2227: 2225: 2223: 2221: 2219: 2217: 2215: 2213: 2211: 2209: 2207: 2205: 2203: 2201: 2199: 829:non-invasive measurement of intracranial pressure 462:, fatigue, fluid dripping from the nose or ears, 4603:Wang, S.; Lirng, J.; Hseu, S.; Chan, K. (2008). 4186:Journal of Vascular and Interventional Radiology 3051: 3049: 3047: 3045: 3043: 3041: 3039: 3037: 3035: 2888: 2886: 2197: 2195: 2193: 2191: 2189: 2187: 2185: 2183: 2181: 2179: 2137: 2135: 2133: 2131: 2129: 2127: 2125: 2123: 2121: 2119: 3664: 3662: 1880: 1878: 1876: 1728: 1726: 674:position to descend, which can be mistaken for 126:leaks out of one or more holes or tears in the 3618: 3616: 3614: 3414:Ragab, Ashraf; Facharzt, Khalid Noman (2014). 2636: 2634: 2285: 2283: 2054:Neil R. Miller; William Fletcher Hoyt (2005). 1121:alternate site after recent repair is common. 5557: 4524:The Canadian Journal of Neurological Sciences 3759:The Canadian Journal of Neurological Sciences 3550:Medicina Oral, Patologia Oral y Cirugia Bucal 2590: 2588: 2586: 2584: 2582: 2580: 2578: 2576: 2057:Walsh and Hoyt's clinical neuro-ophthalmology 1108:meningitis in those with a CSF leak due to a 690:. An extremely rare complication of sCSFL is 8: 5126: 5124: 3495: 3493: 2852: 2850: 1612:Developmental Medicine & Child Neurology 667:, which controls breathing and circulation. 564:autosomal dominant polycystic kidney disease 195:Any CSF leak is most often characterized by 4871:The Cochrane Database of Systematic Reviews 4690:Headache: The Journal of Head and Face Pain 4051:Headache: The Journal of Head and Face Pain 3543: 3541: 3539: 3182: 3180: 3143:Headache: The Journal of Head and Face Pain 3058:Journal of the American Medical Association 1788:Headache: The Journal of Head and Face Pain 1657: 1655: 1653: 1651: 950:and introduction of contrast into the spine 659:is another complication that occurs due to 6282: 6273: 6042: 5710: 5701: 5590: 5564: 5550: 5542: 5429: 4092: 4090: 3089: 3087: 2475:Adams and Victor's principles of neurology 1891:Current Neurology and Neuroscience Reports 1885:Lashkarivand, A; Eide, PK (October 2023). 1038:to clot the sites of holes. The volume of 91: 63: 49: 32: 5265: 5224: 5148: 4890: 4789: 4620: 4535: 4451: 4386: 4062: 4021: 3980: 3770: 3484:"Cerebrospinal Fluid Leak (CSF Leak) FAQ" 3431: 3390: 2971: 2961: 2944:Yee, TJ; Swong, K; Park, P (March 2020). 2920: 2910: 2874: 2396: 2315: 2159: 1910: 1856: 1799: 1758: 1623: 1601: 1599: 1597: 1542: 1275: 1265: 697:There are documented cases of reversible 4824:Operative Neurosurgery (Hagerstown, Md.) 2374: 2372: 2370: 1837:AJNR. American Journal of Neuroradiology 292: 3370:Journal of Korean Neurosurgical Society 3098:spontaneous intracranial hypotension". 2863:Clinical and Translational Neuroscience 2552:"CSF Leak: A Curable Cause of Headache" 1337: 1335: 1223: 983:Symptomatic treatment usually involves 860:Magnetic resonance imaging of the brain 721:Cerebrospinal fluid is produced by the 525:anterior cervical discectomy and fusion 6353:Distal hereditary motor neuronopathies 6026:Template:Demyelinating diseases of CNS 2418: 2416: 1608:"Spontaneous intracranial hypotension" 1420:AJR. American Journal of Roentgenology 1316:Simon, LV; Newton, EJ (January 2023). 4045:Schievink, W. I.; Tourje, J. (2007). 1979:Neuroimaging Clinics of North America 1468:Neuroimaging Clinics of North America 430:Other symptoms of a CSF leak include 7: 6204:Idiopathic intracranial hypertension 1461: 1459: 1457: 1413: 1411: 1358: 1356: 1025:The epidural syringe is filled with 641:spontaneous intracranial hypotension 483:An untreated CSF leak can result in 458:or difficulties with concentration, 295:Symptoms resulting from nerve impact 264:Spontaneous intracranial hypotension 258:spontaneous intracranial hypotension 218:in 1938 and by American neurologist 18:Spontaneous cerebrospinal fluid leak 5207:Carter, B.; Pasupuleti, R. (2000). 3797:Clinical Neurology and Neurosurgery 831:methods of the CSF pressure, and a 114:) is a medical condition where the 6435:Infantile progressive bulbar palsy 4306:10.1212/01.wnl.0000132964.07982.cc 3697:10.1212/01.wnl.0000218210.83855.40 3334:10.1227/01.NEU.0000089483.30857.11 2857:Beck, Jürgen; et al. (2018). 2825:10.1212/01.wnl.0000267324.68013.8e 1523:European Journal of Human Genetics 893:heavily T2-weighted MR myelography 25: 6138:Template:Cerebrovascular diseases 5941:Frontotemporal lobar degeneration 4477:Current Pain and Headache Reports 3625:Current Pain and Headache Reports 3502:Current Pain and Headache Reports 2597:Current Pain and Headache Reports 1366:American Journal of Roentgenology 6492:Central nervous system disorders 6158:For more detailed coverage, see 6136:For more detailed coverage, see 6107:For more detailed coverage, see 6073:For more detailed coverage, see 6024:For more detailed coverage, see 5346:10.1097/00006123-200209000-00045 5267:10.1097/00000539-200205000-00069 5226:10.1097/00000542-200001000-00043 4791:10.1111/j.1468-1331.2009.02803.x 4748:10.2106/00004623-198971070-00004 4702:10.1111/j.1526-4610.2009.01450.x 4609:Acta Anaesthesiologica Taiwanica 4064:10.1111/j.1526-4610.2007.00934.x 3960:The Journal of Headache and Pain 3328:(5): 1216–8, discussion 1218–9. 3155:10.1111/j.1526-4610.2007.00979.x 2258:10.1111/j.1468-2982.2008.01776.x 1689:Current Opinion in Ophthalmology 1625:10.1111/j.1469-8749.2009.03514.x 1300:Cerebrospinal Fluid Leak Imaging 962:and elevated protein content or 908:Engorgement of venous structures 4996:. 25. Suppl 3 (S3): S293–S295. 3420:Egyptian Journal of Anaesthesia 3363:Kim, K. T.; Kim, Y. B. (2010). 2695:New England Journal of Medicine 2379:Mehta, B.; Tarshis, J. (2009). 1155:journals since the late 1980s. 823:Computed tomography of the head 450:, facial numbness or weakness, 406:second-half-of-the-day headache 5340:(3): 830–6, discussion 836–7. 4883:10.1002/14651858.CD004884.pub4 4375:Journal of Neurosurgery. Spine 3809:10.1016/j.clineuro.2009.06.001 2385:Canadian Journal of Anesthesia 926:Fluid dripping from the nose ( 651:When a CSF leak occurs at the 600:Cranial CSF leaks result from 1: 6451:Amyotrophic lateral sclerosis 6336:Hereditary spastic paraplegia 6194:Normal pressure hydrocephalus 5107:10.1016/S0140-6736(53)91948-5 5068:Neurologia (Barcelona, Spain) 4778:European Journal of Neurology 4622:10.1016/S1875-4597(08)60007-7 3852:10.1016/S0140-6736(07)60636-9 3728:Neurologia (Barcelona, Spain) 3279:American Journal of Rhinology 1948:10.1016/S1474-4422(21)00423-3 670:Low CSF volume can cause the 6420:Progressive muscular atrophy 5496:: 339.8, 348.4, 349.0, 792.0 5311:10.1016/j.neurol.2008.05.006 4155:10.1212/WNL.0b013e3181c3fd99 4112:10.3109/02699052.2010.490512 3929:10.1016/j.spinee.2005.12.026 3248:10.1097/MOO.0b013e3283200017 3010:10.1097/BRS.0000000000000404 1751:10.1001/jamaneurol.2020.4799 1701:10.1097/ICU.0000000000000603 1343:"Are all CSF leaks similar?" 611:CSF leaks can result from a 156:post-dural-puncture headache 5930:Primary progressive aphasia 4658:10.3171/jns.2004.100.6.1098 4023:10.1001/archneur.60.12.1713 905:Enhancement of the meninges 499:Cranial leaks occur in the 178:connective tissue disorders 6508: 6252:Hashimoto's encephalopathy 5958:Posterior cortical atrophy 5779:Striatonigral degeneration 5630:Cavernous sinus thrombosis 5389:10.3171/jns.2002.96.3.0483 5186:10.3171/jns.1989.70.5.0808 4963:10.3171/jns.1998.88.2.0243 4928:10.3171/jns.2003.99.5.0840 4388:10.3171/2015.10.SPINE15855 4335:Mark S. Greenberg (2006). 4198:10.1016/j.jvir.2017.10.002 3433:10.1016/j.egja.2013.11.005 3291:10.1177/194589240301700403 2296:Emergency Medicine Journal 1903:10.1007/s11910-023-01297-9 1347:Spinal CSF Leak Foundation 1014: 999:infusion), and hydration. 902:Subdural fluid collections 866:Magnetic resonance imaging 857: 820: 628:Arnold–Chiari malformation 549:connective tissue disorder 154:can give the symptom of a 6358:Spinal muscular atrophies 6326:Primary lateral sclerosis 6184:Intracranial hypertension 5964:Creutzfeldt–Jakob disease 5002:10.1007/s10072-004-0315-3 4574:10.1007/s10072-004-0272-x 4537:10.1017/s0317167100007654 4489:10.1007/s11916-014-0457-9 4341:. Thieme. pp. 178–. 4004:Schievink, W. I. (2003). 3973:10.1007/s10194-007-0421-8 3772:10.1017/s0317167100006636 3637:10.1007/s11916-007-0023-9 3514:10.1007/s11916-001-0045-7 3383:10.3340/jkns.2010.47.1.48 2912:10.1186/s12893-019-0527-3 2655:10.1007/s00062-009-9008-x 2643:Klinische Neuroradiologie 2609:10.1007/s11916-014-0425-4 2522:10.1007/s00415-011-6181-z 2437:10.1007/s10072-009-0060-8 2398:10.1007/s12630-009-9121-y 1991:10.1016/j.nic.2019.01.002 1580:10.1148/radiol.2483070362 1480:10.1016/j.nic.2019.07.006 630:is a condition where the 602:intracranial hypertension 245:Intracranial hypertension 118:(CSF) that surrounds the 71: 62: 57: 48: 6425:Progressive bulbar palsy 6216:Intracranial hypotension 6199:Choroid plexus papilloma 5613:Herpesviral encephalitis 5254:Anesthesia and Analgesia 5045:10.3171/2008.10.JNS08428 4338:Handbook of neurosurgery 3112:10.1177/0333102410394676 3070:10.1001/jama.295.19.2286 2950:Journal of Spine Surgery 2876:10.1177/2514183X18787371 2750:10.1177/0333102414531154 2023:Handbook of neurosurgery 2020:Greenberg, Mark (2006). 1887:"Brain Sagging Dementia" 1267:10.3390/brainsci12030340 1232:MedlinePlus Encyclopedia 1191:thoracic aortic aneurysm 1059:Surgical drain technique 543:Connective tissue theory 274:intracranial hypotension 190:intracranial hypotension 104:cerebrospinal fluid leak 36:Cerebrospinal fluid leak 5937:Frontotemporal dementia 5623:Encephalitis lethargica 5377:Journal of Neurosurgery 5174:Journal of Neurosurgery 5033:Journal of Neurosurgery 4951:Journal of Neurosurgery 4916:Journal of Neurosurgery 4646:Journal of Neurosurgery 4518:Peng, PW; Farb (2008). 3202:10.3171/2009.6.JNS09415 3190:Journal of Neurosurgery 2963:10.21037/jss.2020.01.14 2508:spontaneous CSF leak". 2353:10.3171/2008.9.JNS08670 2341:Journal of Neurosurgery 2308:10.1136/emj.2007.048694 2090:Mayo Clinic Proceedings 1318:Basilar Skull Fractures 1112:is of unclear benefit. 960:lymphocytic pleocytosis 946:Spinal needles used in 878:cerebral venous sinuses 746:(large opening) of the 699:frontotemporal dementia 657:Orthostatic hypotension 478:frontotemporal dementia 207:injection, or surgery. 186:Ehlers–Danlos syndromes 172:not associated with an 6242:Hepatic encephalopathy 5424:Spinal CSF leak Canada 5150:10.3171/foc.2000.9.1.6 4436:10.5152/dir.2017.17220 2869:(2): 2514183X1878737. 2161:10.3171/foc.2000.9.1.8 2142:Schievink, WI (2000). 1110:basilar skull fracture 1030: 951: 760:brain sagging dementia 707:Trendelenburg position 635: 582:Spinal drainage theory 560:Ehlers–Danlos syndrome 518:spinal disc herniation 410:lying flat on the back 148:basilar skull fracture 6300:Ataxia–telangiectasia 6257:Static encephalopathy 5980:Mitochondrial disease 5818:Spasmodic torticollis 5728:Basal ganglia disease 4994:Neurological Sciences 4562:Neurological Sciences 4263:10.1212/wnl.62.8.1453 4010:Archives of Neurology 3884:Head and neuroanatomy 2707:10.1056/NEJMra2101561 2425:Neurological Sciences 1936:The Lancet. Neurology 1535:10.1038/ejhg.2012.191 1024: 945: 811:psychiatric disorders 661:autonomic dysfunction 645:orthostatic headaches 626: 468:cranial nerve 6 palsy 197:orthostatic headaches 6247:Toxic encephalopathy 5953:Lewy bodies dementia 2893:Feichter I. (2019). 2792:www.researchgate.net 2556:www.cedars-sinai.edu 2510:Journal of Neurology 1432:10.2214/AJR.17.18351 1378:10.2214/AJR.15.14884 1170:to treat CSF leaks. 1072:Neurosurgical repair 1017:Epidural blood patch 1011:Epidural blood patch 914:Sagging of the brain 776:clinical examination 711:Empty sella syndrome 684:hindbrain herniation 402:orthostatic headache 201:epidural blood patch 6295:Friedreich's ataxia 5678:Meningoencephalitis 5618:Limbic encephalitis 5137:Neurosurgical Focus 3458:. 20 February 2015. 2148:Neurosurgical Focus 1606:Gordon, N. (2009). 1187:arterial tortuosity 1047:Fibrin glue sealant 882:Chiari malformation 844:radiocontrast agent 833:computed tomography 807:Chiari malformation 676:Chiari malformation 572:joint hypermobility 297: 216:Georg Schaltenbrand 116:cerebrospinal fluid 6331:Pseudobulbar palsy 6069:Status epilepticus 6020:Multiple sclerosis 5857:Myoclonic epilepsy 5720:movement disorders 5666:Acute disseminated 5608:Viral encephalitis 5516:External resources 5299:Revue Neurologique 4836:10.1093/ons/opz134 4257:(8): 1453.1–1453. 4230:. 28 November 2023 2102:10.4065/74.11.1113 1849:10.3174/ajnr.A7548 1801:10.1111/head.12149 1782:Mokri, B. (2013). 1031: 952: 932:beta-2 transferrin 911:Pituitary swelling 636: 632:cerebellar tonsils 589:inferior vena cava 293: 284:Signs and symptoms 138:including from an 58:Circulation of CSF 6469: 6468: 6465: 6464: 6461: 6460: 6265: 6264: 6170: 6169: 6109:Template:Headache 6075:Template:Epilepsy 5996: 5995: 5970:Vascular dementia 5813:Status dystonicus 5686: 5685: 5661:Encephalomyelitis 5539: 5538: 5131:Mokri, B (2000). 4568:(S3): S135–S137. 4348:978-3-13-110886-9 3917:The Spine Journal 3894:978-3-13-142101-2 3589:10.1159/000084306 2744:(14): 1134–1141. 2701:(23): 2173–2178. 2490:978-0-07-141620-7 2252:(12): 1345–1356. 2096:(11): 1113–1123. 2067:978-0-7817-4811-7 2033:978-0-86577-909-9 1207:Subdural effusion 876:, engorgement of 874:subdural hygromas 788:Valsalva maneuver 692:third nerve palsy 672:cerebellar tonsil 531:Discogenic causes 495:Cranial CSF leaks 444:gait disturbances 398: 397: 394:taste distortion 379:balance problems 366:vestibulocochlear 100: 99: 30:Medical condition 16:(Redirected from 6499: 6283: 6274: 6232:Brain herniation 6043: 5883:Intention tremor 5878:Essential tremor 5743:Postencephalitic 5711: 5702: 5591: 5572:Diseases of the 5566: 5559: 5552: 5543: 5430: 5401: 5400: 5372: 5366: 5365: 5329: 5323: 5322: 5294: 5288: 5287: 5269: 5245: 5239: 5238: 5228: 5204: 5198: 5197: 5169: 5163: 5162: 5152: 5128: 5119: 5118: 5090: 5084: 5083: 5063: 5057: 5056: 5028: 5022: 5021: 4989: 4983: 4982: 4946: 4940: 4939: 4911: 4905: 4904: 4894: 4862: 4856: 4855: 4818: 4812: 4811: 4793: 4769: 4760: 4759: 4731: 4722: 4721: 4696:(7): 1047–1051. 4685: 4670: 4669: 4652:(6): 1098–1100. 4641: 4635: 4634: 4624: 4600: 4594: 4593: 4556: 4550: 4549: 4539: 4515: 4509: 4508: 4472: 4466: 4465: 4455: 4415: 4409: 4408: 4390: 4366: 4360: 4359: 4357: 4355: 4332: 4326: 4325: 4289: 4283: 4282: 4246: 4240: 4239: 4237: 4235: 4224: 4218: 4217: 4181: 4175: 4174: 4138: 4132: 4131: 4094: 4085: 4084: 4066: 4042: 4036: 4035: 4025: 4001: 3995: 3994: 3984: 3950: 3941: 3940: 3912: 3906: 3905: 3903: 3901: 3878: 3872: 3871: 3835: 3829: 3828: 3791: 3785: 3784: 3774: 3750: 3744: 3743: 3723: 3717: 3716: 3680: 3674: 3673: 3666: 3657: 3656: 3620: 3609: 3608: 3572: 3566: 3565: 3545: 3534: 3533: 3497: 3488: 3487: 3480: 3474: 3473: 3466: 3460: 3459: 3452: 3446: 3445: 3435: 3411: 3405: 3404: 3394: 3360: 3354: 3353: 3317: 3311: 3310: 3274: 3268: 3267: 3231: 3222: 3221: 3184: 3175: 3174: 3138: 3132: 3131: 3091: 3082: 3081: 3053: 3030: 3029: 2992: 2986: 2985: 2975: 2965: 2941: 2935: 2934: 2924: 2914: 2890: 2881: 2880: 2878: 2854: 2845: 2844: 2808: 2802: 2801: 2799: 2798: 2784: 2778: 2777: 2733: 2727: 2726: 2690: 2675: 2674: 2638: 2629: 2628: 2592: 2571: 2570: 2568: 2567: 2558:. Archived from 2548: 2542: 2541: 2506:manifestation of 2501: 2495: 2494: 2478: 2468: 2457: 2456: 2420: 2411: 2410: 2400: 2376: 2365: 2364: 2336: 2330: 2329: 2319: 2287: 2278: 2277: 2241: 2174: 2173: 2163: 2139: 2114: 2113: 2085: 2079: 2078: 2076: 2074: 2051: 2045: 2044: 2042: 2040: 2017: 2011: 2010: 1974: 1968: 1967: 1931: 1925: 1924: 1914: 1882: 1871: 1870: 1860: 1843:(7): 1068–1072. 1828: 1822: 1821: 1803: 1794:(7): 1034–1053. 1779: 1773: 1772: 1762: 1730: 1721: 1720: 1684: 1678: 1677: 1675: 1673: 1659: 1646: 1645: 1627: 1603: 1592: 1591: 1563: 1557: 1556: 1546: 1514: 1508: 1507: 1463: 1452: 1451: 1426:(6): 1360–1366. 1415: 1406: 1405: 1360: 1351: 1350: 1349:. 29 April 2018. 1339: 1330: 1329: 1313: 1307: 1296: 1290: 1289: 1279: 1269: 1245: 1239: 1228: 1096:Adjunct measures 1040:autologous blood 1036:clotting factors 1027:autologous blood 1005:abdominal binder 568:pectus excavatum 385:glossopharyngeal 342:taste distortion 298: 289:Spinal SCF leaks 96: 95: 67: 53: 33: 21: 6507: 6506: 6502: 6501: 6500: 6498: 6497: 6496: 6487:Brain disorders 6472: 6471: 6470: 6457: 6383:Congenital DSMA 6304: 6261: 6220: 6166: 6154:Sleep disorders 6142: 6119:Cerebrovascular 6113: 6079: 6036: 6030: 5992: 5974: 5899: 5845:Choreoathetosis 5718: 5695: 5682: 5646: 5580: 5570: 5540: 5535: 5534: 5511: 5510: 5441: 5419:Spinal CSF leak 5410: 5405: 5404: 5374: 5373: 5369: 5331: 5330: 5326: 5296: 5295: 5291: 5247: 5246: 5242: 5206: 5205: 5201: 5171: 5170: 5166: 5130: 5129: 5122: 5101:(6765): 805–8. 5092: 5091: 5087: 5065: 5064: 5060: 5030: 5029: 5025: 4991: 4990: 4986: 4948: 4947: 4943: 4913: 4912: 4908: 4877:(4): CD004884. 4864: 4863: 4859: 4820: 4819: 4815: 4771: 4770: 4763: 4733: 4732: 4725: 4687: 4686: 4673: 4643: 4642: 4638: 4602: 4601: 4597: 4558: 4557: 4553: 4517: 4516: 4512: 4474: 4473: 4469: 4417: 4416: 4412: 4368: 4367: 4363: 4353: 4351: 4349: 4334: 4333: 4329: 4291: 4290: 4286: 4248: 4247: 4243: 4233: 4231: 4226: 4225: 4221: 4183: 4182: 4178: 4140: 4139: 4135: 4106:(7–8): 988–94. 4096: 4095: 4088: 4044: 4043: 4039: 4003: 4002: 3998: 3952: 3951: 3944: 3914: 3913: 3909: 3899: 3897: 3895: 3880: 3879: 3875: 3837: 3836: 3832: 3793: 3792: 3788: 3752: 3751: 3747: 3725: 3724: 3720: 3682: 3681: 3677: 3668: 3667: 3660: 3622: 3621: 3612: 3574: 3573: 3569: 3556:(5): E397–400. 3547: 3546: 3537: 3499: 3498: 3491: 3482: 3481: 3477: 3468: 3467: 3463: 3454: 3453: 3449: 3413: 3412: 3408: 3362: 3361: 3357: 3319: 3318: 3314: 3276: 3275: 3271: 3233: 3232: 3225: 3186: 3185: 3178: 3140: 3139: 3135: 3093: 3092: 3085: 3064:(19): 2286–96. 3055: 3054: 3033: 3004:(16): E936-43. 2994: 2993: 2989: 2943: 2942: 2938: 2892: 2891: 2884: 2856: 2855: 2848: 2810: 2809: 2805: 2796: 2794: 2786: 2785: 2781: 2735: 2734: 2730: 2692: 2691: 2678: 2640: 2639: 2632: 2594: 2593: 2574: 2565: 2563: 2550: 2549: 2545: 2503: 2502: 2498: 2491: 2470: 2469: 2460: 2431:(S1): S11–S13. 2422: 2421: 2414: 2378: 2377: 2368: 2338: 2337: 2333: 2302:(10): 739–741. 2289: 2288: 2281: 2243: 2242: 2177: 2141: 2140: 2117: 2087: 2086: 2082: 2072: 2070: 2068: 2053: 2052: 2048: 2038: 2036: 2034: 2019: 2018: 2014: 1976: 1975: 1971: 1933: 1932: 1928: 1897:(10): 593–605. 1884: 1883: 1874: 1830: 1829: 1825: 1781: 1780: 1776: 1732: 1731: 1724: 1686: 1685: 1681: 1671: 1669: 1661: 1660: 1649: 1618:(12): 932–935. 1605: 1604: 1595: 1565: 1564: 1560: 1516: 1515: 1511: 1465: 1464: 1455: 1417: 1416: 1409: 1362: 1361: 1354: 1341: 1340: 1333: 1315: 1314: 1310: 1297: 1293: 1247: 1246: 1242: 1229: 1225: 1220: 1203: 1183:Marfan syndrome 1161: 1143: 1127: 1118: 1098: 1074: 1061: 1049: 1019: 1013: 1001:Corticosteroids 981: 972: 956:lumbar puncture 948:lumbar puncture 940: 928:CSF rhinorrhoea 924: 886:whiplash strain 862: 856: 840:lumbar puncture 825: 819: 768: 740: 719: 717:Pathophysiology 621: 613:lumbar puncture 606:nude nerve root 598: 584: 556:Marfan syndrome 545: 533: 509: 497: 387: 378: 373: 368: 359: 358:facial weakness 351: 334: 325: 320: 315: 291: 286: 278:CSF hypovolemia 266: 253: 241: 232: 182:Marfan syndrome 152:lumbar puncture 90: 31: 28: 23: 22: 15: 12: 11: 5: 6505: 6503: 6495: 6494: 6489: 6484: 6474: 6473: 6467: 6466: 6463: 6462: 6459: 6458: 6456: 6455: 6454: 6453: 6442: 6441: 6440: 6439: 6438: 6437: 6432: 6422: 6417: 6416: 6415: 6410: 6405: 6404: 6403: 6398: 6393: 6385: 6380: 6375: 6370: 6365: 6355: 6341: 6340: 6339: 6338: 6333: 6328: 6314: 6312: 6306: 6305: 6303: 6302: 6297: 6291: 6289: 6280: 6271: 6267: 6266: 6263: 6262: 6260: 6259: 6254: 6249: 6244: 6239: 6234: 6228: 6226: 6222: 6221: 6219: 6218: 6213: 6211:Cerebral edema 6208: 6207: 6206: 6201: 6196: 6191: 6180: 6178: 6172: 6171: 6168: 6167: 6165: 6164: 6163: 6162: 6160:Template:Sleep 6150: 6148: 6144: 6143: 6141: 6140: 6134: 6129: 6123: 6121: 6115: 6114: 6112: 6111: 6105: 6100: 6095: 6089: 6087: 6081: 6080: 6078: 6077: 6071: 6066: 6061: 6055: 6053: 6040: 6032: 6031: 6029: 6028: 6022: 6017: 6012: 6006: 6004: 5998: 5997: 5994: 5993: 5991: 5990: 5988:Leigh syndrome 5984: 5982: 5976: 5975: 5973: 5972: 5961: 5960: 5955: 5950: 5949: 5948: 5934: 5933: 5932: 5927: 5926: 5925: 5909: 5907: 5901: 5900: 5898: 5897: 5892: 5887: 5886: 5885: 5880: 5869: 5868: 5867: 5866: 5861: 5860: 5859: 5849: 5848: 5847: 5837: 5832: 5831: 5830: 5825: 5820: 5815: 5799: 5798: 5797: 5796: 5791: 5786: 5781: 5776: 5775: 5774: 5764: 5763: 5762: 5752: 5751: 5750: 5745: 5740: 5724: 5722: 5715:Extrapyramidal 5708: 5699: 5697:encephalopathy 5688: 5687: 5684: 5683: 5681: 5680: 5675: 5670: 5669: 5668: 5657: 5655: 5648: 5647: 5645: 5644: 5643: 5642: 5632: 5627: 5626: 5625: 5620: 5615: 5610: 5599: 5597: 5588: 5582: 5581: 5574:nervous system 5571: 5569: 5568: 5561: 5554: 5546: 5537: 5536: 5533: 5532: 5520: 5519: 5517: 5513: 5512: 5509: 5508: 5497: 5485: 5466: 5442: 5437: 5436: 5434: 5433:Classification 5427: 5426: 5421: 5416: 5409: 5408:External links 5406: 5403: 5402: 5367: 5324: 5289: 5240: 5219:(1): 272–274. 5213:Anesthesiology 5199: 5164: 5120: 5085: 5058: 5039:(2): 295–299. 5023: 4984: 4957:(2): 243–246. 4941: 4922:(5): 840–842. 4906: 4857: 4830:(3): 239–245. 4813: 4784:(12): e178–9. 4761: 4723: 4671: 4636: 4615:(3): 129–133. 4595: 4551: 4510: 4467: 4410: 4381:(6): 960–964. 4361: 4347: 4327: 4284: 4241: 4219: 4176: 4149:(22): 1892–8. 4133: 4086: 4037: 4016:(12): 1713–8. 3996: 3967:(6): 325–328. 3942: 3907: 3893: 3873: 3846:(9570): 1402. 3830: 3803:(8): 699–702. 3786: 3745: 3718: 3691:(11): 1777–8. 3675: 3658: 3610: 3567: 3535: 3489: 3475: 3461: 3447: 3426:(2): 181–186. 3406: 3355: 3312: 3269: 3223: 3176: 3149:(1): 146–149. 3133: 3106:(6): 691–695. 3083: 3031: 2987: 2956:(1): 302–322. 2936: 2882: 2846: 2819:(7): 700–702. 2803: 2779: 2728: 2676: 2649:(2): 111–121. 2630: 2572: 2543: 2496: 2489: 2458: 2412: 2366: 2347:(3): 521–524. 2331: 2279: 2175: 2115: 2080: 2066: 2046: 2032: 2012: 1985:(2): 213–226. 1969: 1942:(4): 369–380. 1926: 1872: 1823: 1774: 1745:(3): 329–337. 1739:JAMA Neurology 1722: 1695:(6): 467–471. 1679: 1647: 1593: 1558: 1529:(4): 386–390. 1509: 1474:(4): 581–594. 1453: 1407: 1352: 1331: 1308: 1291: 1254:Brain Sciences 1240: 1222: 1221: 1219: 1216: 1215: 1214: 1212:Cerebral shunt 1209: 1202: 1199: 1164:Tetracosactide 1160: 1157: 1142: 1139: 1131:emergency room 1126: 1123: 1117: 1114: 1097: 1094: 1073: 1070: 1060: 1057: 1048: 1045: 1015:Main article: 1012: 1009: 980: 977: 971: 968: 939: 936: 923: 920: 916: 915: 912: 909: 906: 903: 858:Main article: 855: 852: 821:Main article: 818: 815: 767: 764: 748:occipital bone 744:foramen magnum 739: 736: 723:choroid plexus 718: 715: 620: 617: 597: 594: 583: 580: 544: 541: 532: 529: 508: 505: 496: 493: 489:foramen magnum 454:disturbances, 419:or stiffness, 396: 395: 392: 389: 381: 380: 375: 370: 362: 361: 356: 353: 345: 344: 339: 336: 332:chorda tympani 328: 327: 326:double vision 324:blurred and or 322: 317: 309: 308: 305: 302: 290: 287: 285: 282: 265: 262: 252: 249: 240: 237: 231: 230:Classification 228: 226:in the 1950s. 168:or CSF-venous 98: 97: 84: 78: 77: 69: 68: 60: 59: 55: 54: 46: 45: 42: 38: 37: 29: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 6504: 6493: 6490: 6488: 6485: 6483: 6480: 6479: 6477: 6452: 6449: 6448: 6447: 6444: 6443: 6436: 6433: 6431: 6428: 6427: 6426: 6423: 6421: 6418: 6414: 6411: 6409: 6406: 6402: 6399: 6397: 6394: 6392: 6389: 6388: 6386: 6384: 6381: 6379: 6376: 6374: 6371: 6369: 6366: 6364: 6361: 6360: 6359: 6356: 6354: 6351: 6350: 6349: 6347: 6343: 6342: 6337: 6334: 6332: 6329: 6327: 6324: 6323: 6322: 6320: 6316: 6315: 6313: 6311: 6307: 6301: 6298: 6296: 6293: 6292: 6290: 6288: 6284: 6281: 6279: 6275: 6272: 6268: 6258: 6255: 6253: 6250: 6248: 6245: 6243: 6240: 6238: 6237:Reye syndrome 6235: 6233: 6230: 6229: 6227: 6223: 6217: 6214: 6212: 6209: 6205: 6202: 6200: 6197: 6195: 6192: 6190: 6189:Hydrocephalus 6187: 6186: 6185: 6182: 6181: 6179: 6177: 6173: 6161: 6157: 6156: 6155: 6152: 6151: 6149: 6145: 6139: 6135: 6133: 6130: 6128: 6125: 6124: 6122: 6120: 6116: 6110: 6106: 6104: 6101: 6099: 6096: 6094: 6091: 6090: 6088: 6086: 6082: 6076: 6072: 6070: 6067: 6065: 6062: 6060: 6057: 6056: 6054: 6052: 6048: 6044: 6041: 6039: 6033: 6027: 6023: 6021: 6018: 6016: 6013: 6011: 6008: 6007: 6005: 6003: 6002:Demyelinating 5999: 5989: 5986: 5985: 5983: 5981: 5977: 5971: 5968: 5967: 5966: 5965: 5959: 5956: 5954: 5951: 5947: 5944: 5943: 5942: 5938: 5935: 5931: 5928: 5924: 5921: 5920: 5919: 5916: 5915: 5914: 5911: 5910: 5908: 5906: 5902: 5896: 5893: 5891: 5890:Restless legs 5888: 5884: 5881: 5879: 5876: 5875: 5874: 5871: 5870: 5865: 5862: 5858: 5855: 5854: 5853: 5850: 5846: 5843: 5842: 5841: 5838: 5836: 5833: 5829: 5828:Blepharospasm 5826: 5824: 5821: 5819: 5816: 5814: 5811: 5810: 5809: 5806: 5805: 5804: 5801: 5800: 5795: 5792: 5790: 5787: 5785: 5784:Hemiballismus 5782: 5780: 5777: 5773: 5770: 5769: 5768: 5765: 5761: 5758: 5757: 5756: 5753: 5749: 5746: 5744: 5741: 5739: 5736: 5735: 5734: 5731: 5730: 5729: 5726: 5725: 5723: 5721: 5716: 5712: 5709: 5707: 5703: 5700: 5698: 5693: 5689: 5679: 5676: 5674: 5671: 5667: 5664: 5663: 5662: 5659: 5658: 5656: 5654: 5649: 5641: 5638: 5637: 5636: 5635:Brain abscess 5633: 5631: 5628: 5624: 5621: 5619: 5616: 5614: 5611: 5609: 5606: 5605: 5604: 5601: 5600: 5598: 5596: 5592: 5589: 5587: 5583: 5579: 5575: 5567: 5562: 5560: 5555: 5553: 5548: 5547: 5544: 5531: 5527: 5526: 5522: 5521: 5518: 5514: 5507: 5503: 5502: 5498: 5495: 5494: 5490: 5486: 5484: 5480: 5476: 5475: 5471: 5467: 5465: 5461: 5457: 5453: 5452: 5448: 5444: 5443: 5440: 5435: 5431: 5425: 5422: 5420: 5417: 5415: 5414:CSF leak info 5412: 5411: 5407: 5398: 5394: 5390: 5386: 5382: 5378: 5371: 5368: 5363: 5359: 5355: 5351: 5347: 5343: 5339: 5335: 5328: 5325: 5320: 5316: 5312: 5308: 5304: 5300: 5293: 5290: 5285: 5281: 5277: 5273: 5268: 5263: 5259: 5255: 5251: 5244: 5241: 5236: 5232: 5227: 5222: 5218: 5214: 5210: 5203: 5200: 5195: 5191: 5187: 5183: 5180:(5): 808–10. 5179: 5175: 5168: 5165: 5160: 5156: 5151: 5146: 5142: 5138: 5134: 5127: 5125: 5121: 5116: 5112: 5108: 5104: 5100: 5096: 5089: 5086: 5081: 5077: 5073: 5069: 5062: 5059: 5054: 5050: 5046: 5042: 5038: 5034: 5027: 5024: 5019: 5015: 5011: 5007: 5003: 4999: 4995: 4988: 4985: 4980: 4976: 4972: 4968: 4964: 4960: 4956: 4952: 4945: 4942: 4937: 4933: 4929: 4925: 4921: 4917: 4910: 4907: 4902: 4898: 4893: 4888: 4884: 4880: 4876: 4872: 4868: 4861: 4858: 4853: 4849: 4845: 4841: 4837: 4833: 4829: 4825: 4817: 4814: 4809: 4805: 4801: 4797: 4792: 4787: 4783: 4779: 4775: 4768: 4766: 4762: 4757: 4753: 4749: 4745: 4741: 4737: 4730: 4728: 4724: 4719: 4715: 4711: 4707: 4703: 4699: 4695: 4691: 4684: 4682: 4680: 4678: 4676: 4672: 4667: 4663: 4659: 4655: 4651: 4647: 4640: 4637: 4632: 4628: 4623: 4618: 4614: 4610: 4606: 4599: 4596: 4591: 4587: 4583: 4579: 4575: 4571: 4567: 4563: 4555: 4552: 4547: 4543: 4538: 4533: 4529: 4525: 4521: 4514: 4511: 4506: 4502: 4498: 4494: 4490: 4486: 4482: 4478: 4471: 4468: 4463: 4459: 4454: 4449: 4445: 4441: 4437: 4433: 4429: 4425: 4421: 4414: 4411: 4406: 4402: 4398: 4394: 4389: 4384: 4380: 4376: 4372: 4365: 4362: 4350: 4344: 4340: 4339: 4331: 4328: 4323: 4319: 4315: 4311: 4307: 4303: 4299: 4295: 4288: 4285: 4280: 4276: 4272: 4268: 4264: 4260: 4256: 4252: 4245: 4242: 4229: 4223: 4220: 4215: 4211: 4207: 4203: 4199: 4195: 4191: 4187: 4180: 4177: 4172: 4168: 4164: 4160: 4156: 4152: 4148: 4144: 4137: 4134: 4129: 4125: 4121: 4117: 4113: 4109: 4105: 4101: 4093: 4091: 4087: 4082: 4078: 4074: 4070: 4065: 4060: 4057:(9): 1345–6. 4056: 4052: 4048: 4041: 4038: 4033: 4029: 4024: 4019: 4015: 4011: 4007: 4000: 3997: 3992: 3988: 3983: 3978: 3974: 3970: 3966: 3962: 3961: 3956: 3949: 3947: 3943: 3938: 3934: 3930: 3926: 3922: 3918: 3911: 3908: 3896: 3890: 3886: 3885: 3877: 3874: 3869: 3865: 3861: 3857: 3853: 3849: 3845: 3841: 3834: 3831: 3826: 3822: 3818: 3814: 3810: 3806: 3802: 3798: 3790: 3787: 3782: 3778: 3773: 3768: 3764: 3760: 3756: 3749: 3746: 3741: 3737: 3733: 3729: 3722: 3719: 3714: 3710: 3706: 3702: 3698: 3694: 3690: 3686: 3679: 3676: 3671: 3665: 3663: 3659: 3654: 3650: 3646: 3642: 3638: 3634: 3630: 3626: 3619: 3617: 3615: 3611: 3606: 3602: 3598: 3594: 3590: 3586: 3582: 3578: 3571: 3568: 3563: 3559: 3555: 3551: 3544: 3542: 3540: 3536: 3531: 3527: 3523: 3519: 3515: 3511: 3508:(3): 284–91. 3507: 3503: 3496: 3494: 3490: 3485: 3479: 3476: 3471: 3465: 3462: 3457: 3451: 3448: 3443: 3439: 3434: 3429: 3425: 3421: 3417: 3410: 3407: 3402: 3398: 3393: 3388: 3384: 3380: 3376: 3372: 3371: 3366: 3359: 3356: 3351: 3347: 3343: 3339: 3335: 3331: 3327: 3323: 3316: 3313: 3308: 3304: 3300: 3296: 3292: 3288: 3284: 3280: 3273: 3270: 3265: 3261: 3257: 3253: 3249: 3245: 3241: 3237: 3230: 3228: 3224: 3219: 3215: 3211: 3207: 3203: 3199: 3195: 3191: 3183: 3181: 3177: 3172: 3168: 3164: 3160: 3156: 3152: 3148: 3144: 3137: 3134: 3129: 3125: 3121: 3117: 3113: 3109: 3105: 3101: 3097: 3096:patients with 3090: 3088: 3084: 3079: 3075: 3071: 3067: 3063: 3059: 3052: 3050: 3048: 3046: 3044: 3042: 3040: 3038: 3036: 3032: 3027: 3023: 3019: 3015: 3011: 3007: 3003: 2999: 2991: 2988: 2983: 2979: 2974: 2969: 2964: 2959: 2955: 2951: 2947: 2940: 2937: 2932: 2928: 2923: 2918: 2913: 2908: 2904: 2900: 2896: 2889: 2887: 2883: 2877: 2872: 2868: 2864: 2860: 2853: 2851: 2847: 2842: 2838: 2834: 2830: 2826: 2822: 2818: 2814: 2807: 2804: 2793: 2789: 2783: 2780: 2775: 2771: 2767: 2763: 2759: 2755: 2751: 2747: 2743: 2739: 2732: 2729: 2724: 2720: 2716: 2712: 2708: 2704: 2700: 2696: 2689: 2687: 2685: 2683: 2681: 2677: 2672: 2668: 2664: 2660: 2656: 2652: 2648: 2644: 2637: 2635: 2631: 2626: 2622: 2618: 2614: 2610: 2606: 2602: 2598: 2591: 2589: 2587: 2585: 2583: 2581: 2579: 2577: 2573: 2562:on 2018-08-01 2561: 2557: 2553: 2547: 2544: 2539: 2535: 2531: 2527: 2523: 2519: 2516:(2): 306–10. 2515: 2511: 2507: 2500: 2497: 2492: 2486: 2482: 2477: 2476: 2467: 2465: 2463: 2459: 2454: 2450: 2446: 2442: 2438: 2434: 2430: 2426: 2419: 2417: 2413: 2408: 2404: 2399: 2394: 2391:(8): 609–13. 2390: 2386: 2382: 2375: 2373: 2371: 2367: 2362: 2358: 2354: 2350: 2346: 2342: 2335: 2332: 2327: 2323: 2318: 2313: 2309: 2305: 2301: 2297: 2293: 2286: 2284: 2280: 2275: 2271: 2267: 2263: 2259: 2255: 2251: 2247: 2240: 2238: 2236: 2234: 2232: 2230: 2228: 2226: 2224: 2222: 2220: 2218: 2216: 2214: 2212: 2210: 2208: 2206: 2204: 2202: 2200: 2198: 2196: 2194: 2192: 2190: 2188: 2186: 2184: 2182: 2180: 2176: 2171: 2167: 2162: 2157: 2153: 2149: 2145: 2138: 2136: 2134: 2132: 2130: 2128: 2126: 2124: 2122: 2120: 2116: 2111: 2107: 2103: 2099: 2095: 2091: 2084: 2081: 2069: 2063: 2059: 2058: 2050: 2047: 2035: 2029: 2025: 2024: 2016: 2013: 2008: 2004: 2000: 1996: 1992: 1988: 1984: 1980: 1973: 1970: 1965: 1961: 1957: 1953: 1949: 1945: 1941: 1937: 1930: 1927: 1922: 1918: 1913: 1908: 1904: 1900: 1896: 1892: 1888: 1881: 1879: 1877: 1873: 1868: 1864: 1859: 1854: 1850: 1846: 1842: 1838: 1834: 1827: 1824: 1819: 1815: 1811: 1807: 1802: 1797: 1793: 1789: 1785: 1778: 1775: 1770: 1766: 1761: 1756: 1752: 1748: 1744: 1740: 1736: 1729: 1727: 1723: 1718: 1714: 1710: 1706: 1702: 1698: 1694: 1690: 1683: 1680: 1668: 1664: 1658: 1656: 1654: 1652: 1648: 1643: 1639: 1635: 1631: 1626: 1621: 1617: 1613: 1609: 1602: 1600: 1598: 1594: 1589: 1585: 1581: 1577: 1574:(3): 725–36. 1573: 1569: 1562: 1559: 1554: 1550: 1545: 1540: 1536: 1532: 1528: 1524: 1520: 1513: 1510: 1505: 1501: 1497: 1493: 1489: 1485: 1481: 1477: 1473: 1469: 1462: 1460: 1458: 1454: 1449: 1445: 1441: 1437: 1433: 1429: 1425: 1421: 1414: 1412: 1408: 1403: 1399: 1395: 1391: 1387: 1383: 1379: 1375: 1371: 1367: 1359: 1357: 1353: 1348: 1344: 1338: 1336: 1332: 1327: 1323: 1319: 1312: 1309: 1306: 1302: 1301: 1295: 1292: 1287: 1283: 1278: 1273: 1268: 1263: 1259: 1255: 1251: 1244: 1241: 1238: 1234: 1233: 1227: 1224: 1217: 1213: 1210: 1208: 1205: 1204: 1200: 1198: 1196: 1192: 1188: 1184: 1180: 1175: 1171: 1169: 1168:intravenously 1165: 1158: 1156: 1153: 1149: 1148:Henry Woltman 1140: 1138: 1134: 1132: 1124: 1122: 1115: 1113: 1111: 1107: 1103: 1095: 1093: 1091: 1087: 1083: 1079: 1071: 1069: 1066: 1058: 1056: 1054: 1046: 1044: 1041: 1037: 1028: 1023: 1018: 1010: 1008: 1006: 1002: 998: 994: 990: 986: 978: 976: 969: 967: 965: 964:xanthochromia 961: 957: 949: 944: 937: 935: 933: 929: 921: 919: 913: 910: 907: 904: 901: 900: 899: 896: 894: 889: 888:to the dura. 887: 883: 879: 875: 872:enlargement, 871: 867: 861: 853: 851: 849: 845: 841: 837: 834: 830: 824: 816: 814: 812: 808: 804: 800: 795: 791: 789: 785: 781: 778:. The use of 777: 773: 765: 763: 761: 757: 753: 752:cranial nerve 749: 745: 738:Brain sagging 737: 735: 733: 732:venous plexus 728: 724: 716: 714: 712: 708: 704: 700: 695: 693: 689: 685: 681: 677: 673: 668: 666: 662: 658: 654: 653:temporal bone 648: 646: 642: 633: 629: 625: 619:Complications 618: 616: 614: 609: 607: 603: 595: 593: 590: 581: 579: 577: 576:arched palate 573: 569: 565: 561: 557: 552: 550: 542: 540: 538: 530: 528: 526: 521: 519: 515: 506: 504: 502: 494: 492: 490: 486: 481: 479: 474: 471: 470:) or tremor. 469: 463: 461: 457: 453: 449: 445: 441: 437: 433: 428: 426: 422: 418: 413: 411: 407: 403: 393: 390: 386: 383: 382: 376: 371: 367: 364: 363: 360:and numbness 357: 354: 350: 347: 346: 343: 340: 337: 335:(Branch of 7) 333: 330: 329: 323: 318: 314: 311: 310: 306: 303: 300: 299: 296: 288: 283: 281: 279: 275: 269: 263: 261: 259: 250: 248: 246: 238: 236: 229: 227: 225: 221: 220:Henry Woltman 217: 214: 208: 206: 202: 198: 193: 191: 187: 183: 179: 175: 174:epidural leak 171: 167: 164: 159: 157: 153: 149: 145: 141: 137: 133: 129: 125: 121: 117: 113: 109: 105: 94: 88: 85: 83: 79: 75: 70: 66: 61: 56: 52: 47: 43: 39: 34: 19: 6445: 6344: 6317: 6278:Degenerative 6015:Inflammatory 5962: 5895:Stiff-person 5733:Parkinsonism 5706:Degenerative 5603:Encephalitis 5586:Inflammation 5576:, primarily 5523: 5499: 5487: 5468: 5445: 5383:(3): 483–9. 5380: 5376: 5370: 5337: 5334:Neurosurgery 5333: 5327: 5305:(2): 201–5. 5302: 5298: 5292: 5257: 5253: 5243: 5216: 5212: 5202: 5177: 5173: 5167: 5140: 5136: 5098: 5094: 5088: 5074:(7): 485–7. 5071: 5067: 5061: 5036: 5032: 5026: 4993: 4987: 4954: 4950: 4944: 4919: 4915: 4909: 4874: 4870: 4860: 4827: 4823: 4816: 4781: 4777: 4742:(7): 984–7. 4739: 4735: 4693: 4689: 4649: 4645: 4639: 4612: 4608: 4598: 4565: 4561: 4554: 4530:(1): 102–5. 4527: 4523: 4513: 4483:(457): 1–9. 4480: 4476: 4470: 4430:(1): 54–59. 4427: 4423: 4413: 4378: 4374: 4364: 4352:. Retrieved 4337: 4330: 4300:(1): 186–7. 4297: 4293: 4287: 4254: 4250: 4244: 4232:. Retrieved 4222: 4189: 4185: 4179: 4146: 4142: 4136: 4103: 4100:Brain Injury 4099: 4054: 4050: 4040: 4013: 4009: 3999: 3964: 3958: 3923:(5): 591–9. 3920: 3916: 3910: 3898:. Retrieved 3883: 3876: 3843: 3839: 3833: 3800: 3796: 3789: 3765:(2): 252–6. 3762: 3758: 3748: 3734:(7): 462–5. 3731: 3727: 3721: 3688: 3684: 3678: 3631:(1): 56–61. 3628: 3624: 3580: 3576: 3570: 3553: 3549: 3505: 3501: 3478: 3464: 3450: 3423: 3419: 3409: 3377:(1): 48–50. 3374: 3368: 3358: 3325: 3322:Neurosurgery 3321: 3315: 3285:(4): 191–5. 3282: 3278: 3272: 3242:(1): 59–65. 3239: 3235: 3196:(2): 300–6. 3193: 3189: 3146: 3142: 3136: 3103: 3099: 3095: 3061: 3057: 3001: 2997: 2990: 2953: 2949: 2939: 2902: 2898: 2866: 2862: 2816: 2812: 2806: 2795:. Retrieved 2791: 2782: 2741: 2737: 2731: 2698: 2694: 2646: 2642: 2600: 2596: 2564:. Retrieved 2560:the original 2555: 2546: 2513: 2509: 2505: 2499: 2474: 2428: 2424: 2388: 2384: 2344: 2340: 2334: 2299: 2295: 2249: 2245: 2151: 2147: 2093: 2089: 2083: 2071:. Retrieved 2056: 2049: 2037:. Retrieved 2022: 2015: 1982: 1978: 1972: 1939: 1935: 1929: 1894: 1890: 1840: 1836: 1826: 1791: 1787: 1777: 1742: 1738: 1692: 1688: 1682: 1670:. Retrieved 1666: 1615: 1611: 1571: 1567: 1561: 1526: 1522: 1512: 1471: 1467: 1423: 1419: 1369: 1365: 1346: 1317: 1311: 1298: 1294: 1257: 1253: 1243: 1230: 1226: 1176: 1172: 1162: 1144: 1135: 1128: 1125:Epidemiology 1119: 1099: 1075: 1065:lumbar drain 1062: 1050: 1032: 991:intake (via 982: 973: 953: 938:CSF analysis 925: 917: 897: 890: 863: 826: 796: 792: 769: 759: 741: 720: 696: 680:quadriplegia 669: 649: 637: 610: 605: 599: 596:Other causes 585: 553: 546: 534: 522: 510: 498: 482: 475: 472: 464: 429: 414: 405: 399: 355:facial nerve 294: 277: 273: 270: 267: 254: 242: 239:Cranial leak 233: 209: 194: 160: 131: 111: 107: 103: 101: 6482:Spinal cord 6430:Fazio–Londe 6270:Both/either 6064:Generalised 5923:Early-onset 5918:Alzheimer's 5653:spinal cord 5525:MedlinePlus 5260:(5): 1369. 3583:(1): 51–5. 3100:Cephalalgia 2039:18 December 1667:Mayo Clinic 1372:(1): 8–19. 1195:fibrillin-1 1152:Mayo Clinic 1102:antibiotics 1100:The use of 1078:diverticula 1053:fibrin glue 997:intravenous 970:Myelography 848:fluoroscopy 615:procedure. 432:photophobia 377:hearing and 319:optic nerve 251:Spinal leak 224:Mayo Clinic 213:neurologist 205:fibrin glue 166:diverticula 124:spinal cord 41:Other names 6476:Categories 6038:paroxysmal 6010:Autoimmune 5803:Dyskinesia 5673:Meningitis 5651:Brain and 5143:(1): 1–7. 4354:8 November 4234:13 January 4192:(3): 439. 3900:8 November 3887:. Thieme. 3840:The Lancet 2905:(66): 66. 2797:2018-09-22 2603:(6): 1–6. 2566:2018-08-01 2154:(1): 1–9. 2073:8 November 1672:16 January 1260:(3): 340. 1218:References 985:analgesics 803:meningitis 727:ventricles 537:discogenic 514:osteophyte 180:including 144:iatrogenic 128:dura mater 6035:Episodic/ 5913:Tauopathy 5864:Akathisia 5852:Myoclonus 5835:Athetosis 5767:Tauopathy 4844:2332-4260 4444:1305-3612 4397:1547-5646 4294:Neurology 4251:Neurology 4206:1535-7732 4143:Neurology 3685:Neurology 3218:207609670 2813:Neurology 2758:1468-2982 2723:244829127 1964:247111571 1717:201748704 1568:Radiology 1504:202812955 1488:1052-5149 1440:1546-3141 1386:0361-803X 1305:eMedicine 1177:The gene 1116:Prognosis 979:Treatment 870:pituitary 836:myelogram 799:migraines 766:Diagnosis 758:known as 665:brainstem 460:neuralgia 456:brain fog 436:dizziness 417:neck pain 372:hearing, 307:Symptoms 163:meningeal 132:sCSF leak 87:Neurology 82:Specialty 6401:SMALED2B 6396:SMALED2A 6093:Migraine 6085:Headache 6051:epilepsy 6047:Seizures 5905:Dementia 5808:Dystonia 5397:11883832 5354:12188967 5319:19010507 5284:43200053 5276:11973227 5235:10638928 5159:16859267 5115:13036182 5080:19921558 5053:19199465 5018:19720469 5010:15549566 4936:14609162 4901:25918919 4892:10554555 4852:31134267 4800:19863649 4718:25817793 4710:19473279 4666:15200130 4631:18809524 4582:15549523 4546:18380287 4505:19577501 4497:25255993 4462:29217497 4405:26849709 4322:43332925 4314:15249640 4279:35100816 4271:15111706 4214:29455884 4171:22189395 4163:19949036 4120:20545453 4081:19223351 4073:17927653 4032:14676045 3991:18071632 3937:16934734 3860:17448827 3817:19577356 3781:19378725 3740:18726726 3713:42704428 3705:16769965 3653:36869290 3645:17214923 3605:24434779 3597:15753623 3562:17767107 3530:30963142 3522:11309218 3442:71403201 3401:20157378 3350:10793428 3342:14580290 3307:39030096 3299:12962187 3264:35820893 3256:19225307 3210:19591547 3171:32994607 3163:18184297 3128:21554078 3120:21220378 3078:16705110 3026:20105020 3018:25010015 2982:32309668 2931:31226967 2899:BMC Surg 2841:43132714 2833:17698794 2766:24728303 2715:34874632 2671:13544316 2663:19636501 2625:22162918 2617:24760494 2538:43308694 2530:21811806 2453:33678574 2445:19415418 2407:19495908 2361:19012477 2326:17901290 2274:40813766 2266:19037970 2170:16859269 2110:10560599 2007:86400418 1999:30926112 1956:35227413 1921:37676440 1912:10590313 1867:35738670 1818:44300449 1810:23808630 1769:33393980 1709:31449087 1642:39157001 1634:19909307 1588:18710972 1553:22929030 1496:31677732 1448:29023155 1394:26700332 1326:29261908 1286:35326296 1237:CSF leak 1201:See also 1159:Research 1090:gel foam 1082:ligation 1034:blood's 989:caffeine 756:dementia 448:tinnitus 425:vomiting 321:crossing 304:Function 170:fistulas 140:accident 108:CSF leak 74:meninges 44:CSF leak 6413:SMA-PME 6408:SMA-PCH 6391:SMALED1 6103:Tension 6098:Cluster 5823:Meige's 5640:Amoebic 5506:D065634 5362:9552160 5194:2709124 4979:9548722 4971:9452231 4808:6165146 4756:2760094 4590:8388459 4453:5765931 4128:9553904 3982:3476164 3868:5350377 3825:2457796 3392:2817515 2973:7154369 2922:6588915 2774:3100453 2317:2658456 1858:9262061 1760:7783594 1544:3598315 1402:5430158 1277:8945904 1150:of the 1141:History 1106:prevent 1086:pledget 725:in the 440:vertigo 374:balance 222:of the 6132:Stroke 5946:Pick's 5873:Tremor 5840:Chorea 5530:001068 5395: 5360: 5352: 5317: 5282: 5274: 5233: 5192: 5157: 5113: 5095:Lancet 5078: 5051: 5016: 5008: 4977: 4969: 4934: 4899: 4889: 4850: 4842: 4806: 4798: 4754: 4716: 4708: 4664: 4629: 4588: 4580: 4544: 4503: 4495: 4460: 4450: 4442: 4403: 4395: 4345: 4320: 4312: 4277: 4269: 4212: 4204: 4169: 4161: 4126: 4118: 4079: 4071: 4030: 3989: 3979: 3935: 3891: 3866: 3858: 3823: 3815: 3779: 3738: 3711: 3703: 3651: 3643: 3603: 3595: 3560: 3528: 3520: 3440: 3399: 3389: 3348: 3340: 3305: 3297: 3262: 3254: 3216: 3208: 3169: 3161: 3126: 3118: 3076: 3024: 3016: 2980: 2970: 2929: 2919: 2839: 2831: 2772: 2764: 2756: 2721: 2713: 2669: 2661: 2623: 2615: 2536: 2528: 2487: 2483:–543. 2451: 2443: 2405: 2359: 2324: 2314: 2272: 2264: 2168: 2108: 2064: 2030: 2005: 1997: 1962: 1954: 1919: 1909: 1865: 1855: 1816: 1808: 1767: 1757: 1715: 1707: 1640: 1632: 1586: 1551: 1541: 1502: 1494: 1486: 1446: 1438: 1400: 1392: 1384: 1324: 1284: 1274: 1189:, and 1179:TGFBR2 993:coffee 809:, and 688:supine 562:, and 507:Causes 452:visual 423:, and 421:nausea 349:facial 136:trauma 89: 6446:both: 6378:DSMA1 6373:SMAX2 6368:SMAX1 6348:only: 6321:only: 6225:Other 6147:Other 6059:Focal 5692:Brain 5595:Brain 5483:G97.0 5479:G96.0 5358:S2CID 5280:S2CID 5014:S2CID 4975:S2CID 4804:S2CID 4714:S2CID 4586:S2CID 4501:S2CID 4318:S2CID 4275:S2CID 4167:S2CID 4124:S2CID 4077:S2CID 3864:S2CID 3821:S2CID 3709:S2CID 3649:S2CID 3601:S2CID 3526:S2CID 3438:S2CID 3346:S2CID 3303:S2CID 3260:S2CID 3214:S2CID 3167:S2CID 3124:S2CID 3022:S2CID 2998:Spine 2837:S2CID 2770:S2CID 2719:S2CID 2667:S2CID 2621:S2CID 2534:S2CID 2449:S2CID 2270:S2CID 2003:S2CID 1960:S2CID 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