{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:56:42Z","timestamp":1790524602082,"version":"4.1.0"},"reference-count":10,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2025,10,24]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>Spontaneous intracranial hypotension (SIH) is a debilitating condition characterised by orthostatic symptoms resulting from cerebrospinal fluid (CSF) depletion. It is caused by leakage at the spinal level, causing gravitationally dependent downward displacement of intracranial structures. Rarely, severe brain sagging due to SIH can compromise brainstem function to the point of coma and even death. Effective management of such patients requires awareness about SIH as a possible cause of coma and multidisciplinary collaboration between neurocritical care, neurosurgical and neurointerventional services. The management aims to optimise supportive medical management, with early implementation of emergency treatment by placing the patient in a head-down position, and rapid detection and treatment of the CSF leak. We present a rare case of severe SIH resulting in coma from a spinal CSF\u2013venous fistula and review the status of knowledge on this clinical scenario, emphasising current diagnostic techniques, multidisciplinary management and curative interventions.<\/jats:p>","DOI":"10.1136\/pn-2025-004726","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T18:20:29Z","timestamp":1762712429000},"page":"468-471","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Coma from severe spontaneous intracranial hypotension due to a CSF\u2013venous fistula"],"prefix":"10.1136","volume":"26","author":[{"given":"Amin","family":"Yakubu","sequence":"first","affiliation":[{"name":"Neurology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph D","family":"Burns","sequence":"additional","affiliation":[{"name":"Neurology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Pace","sequence":"additional","affiliation":[{"name":"Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"},{"name":"Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil V","family":"Patel","sequence":"additional","affiliation":[{"name":"Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Krings","sequence":"additional","affiliation":[{"name":"Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6129-8061","authenticated-orcid":false,"given":"Emanuele","family":"Orru\u2019","sequence":"additional","affiliation":[{"name":"Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"2026092100401127000_26.5.468.1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.ncl.2024.02.002","article-title":"Spontaneous Intracranial Hypotension: Clinical Presentation, Diagnosis, and Treatment Strategies","volume":"42","author":"Wu","year":"2024","journal-title":"Neurol Clin"},{"key":"2026092100401127000_26.5.468.2","first-page":"e1638","article-title":"Coma: A serious complication of spontaneous intracranial hypotension","volume":"90","author":"Schievink","year":"2018","journal-title":"Neurology (ECronicon)"},{"key":"2026092100401127000_26.5.468.3","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.12.1713"},{"key":"2026092100401127000_26.5.468.4","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6016"},{"key":"2026092100401127000_26.5.468.5","doi-asserted-by":"publisher","DOI":"10.3171\/2012.4.JNS112030"},{"key":"2026092100401127000_26.5.468.6","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2015-001183"},{"key":"2026092100401127000_26.5.468.7","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1177\/15910199231172627","article-title":"Spontaneous intracranial hypotension due to CSF\u2013venous fistula: Evaluation of renal accumulation of contrast following decubitus myelography and maintained decubitus CT to improve fistula localization","volume":"31","author":"Farb","year":"2025","journal-title":"Interv Neuroradiol"},{"key":"2026092100401127000_26.5.468.8","doi-asserted-by":"crossref","DOI":"10.1007\/s00701-024-05935-0","article-title":"Management of cervical CSF-venous fistula causing acute cognitive impairment and coma","volume":"166","author":"Carlton Jones","year":"2024","journal-title":"Acta Neurochir (Wien)"},{"key":"2026092100401127000_26.5.468.9","doi-asserted-by":"crossref","unstructured":"White TG , Turpin J , Shao M , et al . Cerebrospinal fluid venous fistula causing spontaneous intracranial hypotension resulting in venous sinus thrombosis and coma. Interv Neuroradiol 2024. doi:10.1177\/15910199241272582","DOI":"10.1177\/15910199241272582"},{"key":"2026092100401127000_26.5.468.10","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2023-331166"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2025-004726","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:27:45Z","timestamp":1790522865000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2025-004726"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,9]]},"references-count":10,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9,20]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/pn-2025-004726"],"URL":"https:\/\/doi.org\/10.1136\/pn-2025-004726","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,9]]}}}