Intracranial hypotension is defined when the opening pressure of cerebrospinal fluid is less than 6 cm H2O. It is caused by a CSF leak along the neuraxis which can be primary (spontaneous) or secondary to surgery, lumbar puncture, or trauma.

Middle-aged adults are more commonly affected with a female predilection.

Positional headache is the most common complaint.

Imaging has a critical role in diagnosing and identifying the leak.

A contrasted study must be used. Imaging findings include pachymeningeal thickening and enhancement, dural venous distension, tonsillar herniation, and subdural collections.

Identification of CSF leaks may be challenging. Most CSF leaks are seen in the cervical lumbar region which may result from rupture of nerve root diverticulum.