Spinal Cerebrospinal Fluid Leaks/Intracranial Hypotension.

Spinal cerebrospinal fluid (CSF) leaks occur due to CSF volume loss at the level of the spine. They can occur spontaneously, from trauma, or iatrogenic causes. Classically, patients present with orthostatic headache, but atypical presentations also occur. Initial workup involves ruling out other etiologies with careful history, neurologic examination, and MRI of brain/spine. Treatment starts with conservative measures and nontargeted epidural blood patching (EBP). If not successful, precise leak localization is required with myelography. Targeted therapy can be offered, including EBP/fibrin glue, endovascular treatment for CSF-venous fistulas, and spine surgery in appropriate cases. Early diagnosis and treatment improve outcomes.