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. 2025 Jun;31(3):364-368.
doi: 10.1177/15910199231165429. Epub 2023 Mar 22.

Incidence of spontaneous intracranial hypotension in Olmsted County, Minnesota: 2019-2021

Aishwarya Pradeep  1 , Ajay A Madhavan  2 , Waleed Brinjikji  2 , Jeremy K Cutsforth-Gregory  3
Affiliations

Incidence of spontaneous intracranial hypotension in Olmsted County, Minnesota: 2019-2021

Aishwarya Pradeep et al. Interv Neuroradiol. 2025 Jun.

Abstract

BackgroundAs the myriad clinical and radiographic presentations of spontaneous intracranial hypotension are increasingly recognized, disease prevalence appears to rise. True incidence data remain insufficient. We sought to calculate the incidence of spontaneous intracranial hypotension among the residents of Olmsted County, Minnesota.MethodsOur institution is a quaternary care center for spontaneous intracranial hypotension evaluation and provides primary neurologic care for local residents. All patients who were evaluated at our institution from 2019 to 2021 for spontaneous intracranial hypotension were reviewed, and cases of spontaneous intracranial hypotension with advanced imaging work-up using digital subtraction myelography or dynamic computed tomography myelography were identified. Patients who were residents of Olmsted County were identified.ResultsFourteen patients with spontaneous intracranial hypotension were identified in Olmsted County during the study period, all of whom were adults and underwent our institution's standard spontaneous intracranial hypotension work-up. In Olmsted County, the incidence of spontaneous intracranial hypotension was 3.8 per 100,000 adult population, including 3.2 per 100,000 adult females and 2.5 per 100,000 adult males. Seven of 14 patients (50%) had a cerebrospinal fluid-venous fistula.ConclusionThis study uniquely presents the incidence rate of spontaneous intracranial hypotension in the general population of Olmsted County, Minnesota. Spontaneous intracranial hypotension is more common in women than men and has an overall incidence roughly equivalent to that of aneurysmal subarachnoid hemorrhage in Olmsted County, a widely known neurologic condition. Approximately half the cases of spontaneous intracranial hypotension are due to cerebrospinal fluid-venous fistulas, which generally require specialty expertise for diagnosis and treatment.

Keywords: Olmsted County; cerebrospinal fluid leaks; incidence; intracranial hypotension.

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Conflict of interest statement

Authors’ contributionAll author(s) have contributed significantly to the conception, design, data collection, data analysis, writing, and critical revision of this article. Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Inclusion and exclusion process for determining the cohort of spontaneous intracranial hypotension (SIH) cases that are the focus of this study.
Figure 2.
Figure 2.
Calculation method for incidence rates for the adult (including a breakdown by male and female) population of Olmsted County, as well as for type III leaks, which appear to be the most common cause of spontaneous intracranial hypotension (SIH).
See this image and copyright information in PMC

References

    1. Mokri B. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia – evolution of a concept. Mayo Clin Proc 1999; 74: 1113–1123. - PubMed
    1. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295: 2286–2296. - PubMed
    1. Rahman M, Bidari SS, Quisling RG. Spontaneous intracranial hypotension: dilemmas in diagnosis. Neurosurgery 2011; 69: 4–14. - PubMed
    1. Mokri B. Spontaneous intracranial hypotension. Continuum (Minneap Minn) 2015; 21: 1086–1108. - PubMed
    1. Amrhein TJ, Kranz PG. Spontaneous intracranial hypotension: imaging in diagnosis and treatment. Radiol Clin North Am 2019; 57: 439–451. - PubMed

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