{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:47:11Z","timestamp":1792000031181,"version":"4.4.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Growing evidence indicates that chronically raised intracranial pressure (ICP) might cause a spontaneous CSF leak. However, data on the prevalence of idiopathic intracranial hypertension (IIH) and associated clinical features of high ICP among patients presenting with spontaneous CSF leaks are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a retrospective review of patients presenting with spontaneous skull base CSF leaks from 2013 to 2020 at a quaternary care center. Demographic, clinical, and imaging characteristics between groups with versus without IIH were compared using the t-test, chi-square test, or Fisher\u2019s exact test. Generalized estimating equations estimated visual acuity differences. The authors performed a sensitivity analysis to evaluate the sensitivity, specificity, and predictive value of one or more radiological findings suggestive of high ICP for the diagnosis of IIH among patients with CSF leaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 55 patients with CSF leaks with complete data, 34 (62%) met criteria for the diagnosis of definite IIH, with 23 having a known diagnosis of IIH prior to CSF leak diagnosis and an additional 11 meeting criteria after surgical CSF leak repair. Compared with patients without confirmed IIH, these patients were more likely to be female (97% vs 76%, p = 0.03), were younger (mean age 44.4 \u00b1 10.4 vs 56.7 \u00b1 10.7 years, p &lt; 0.0001), and had a higher maximum recorded BMI (mean 40.5 \u00b1 8.9 vs 35.47 \u00b1 5.9, p = 0.03). The presence of 1 or more radiological findings suggestive of high ICP (including empty sella, vertical optic nerve tortuosity, posterior globe flattening, venous sinus stenosis, and low-lying cerebellar tonsils) had a specificity of 0.62 and a positive predictive value (PPV) of 0.75 for diagnostic confirmation of IIH. Specificity and PPV increased to 0.91 and 0.88, respectively, with the presence of 2 or more radiological signs. Both specificity and PPV equaled 1 when 3 or more radiological signs suggestive of high ICP were present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Nearly two-thirds of patients with CSF leaks in this study met criteria for definite IIH, although strict reliance on IIH diagnostic criteria in the setting of CSF leaks might underestimate the true prevalence. In the setting of a CSF leak, the presence of even 1 radiological sign of high ICP has a high PPV for IIH diagnosis. In this study, PPV increased to 100% when 3 radiological signs of high ICP were present.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.10.focus25815","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T05:51:44Z","timestamp":1767246704000},"page":"E9","source":"Crossref","is-referenced-by-count":2,"title":["Clinical features of high intracranial pressure and prevalence of idiopathic intracranial hypertension among patients presenting with spontaneous CSF leaks"],"prefix":"10.3171","volume":"60","author":[{"given":"Michael G.","family":"Carper","sequence":"first","affiliation":[{"name":"Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian H.","family":"Guillot","sequence":"additional","affiliation":[{"name":"Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland;"},{"name":"Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas C.","family":"Gasquet","sequence":"additional","affiliation":[{"name":"Wilmer Biostatistics Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R.","family":"Carey","sequence":"additional","affiliation":[{"name":"Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda D.","family":"Henderson","sequence":"additional","affiliation":[{"name":"Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neuroophthalmol","first-page":"487","article-title":"Do most patients with a spontaneous cerebrospinal fluid leak have idiopathic intracranial hypertension?","volume":"39","author":"Bidot S","year":"2019","unstructured":"Bidot S, Levy JM, Saindane AM, Oyesiku NM, Newman NJ, Biousse V. Do most patients with a spontaneous cerebrospinal fluid leak have idiopathic intracranial hypertension?. J Neuroophthalmol. 2019;39(4):487\u2013495. doi:10.1097\/WNO.0000000000000761"},{"issue":"6","key":"b2","series-title":"Curr Opin Ophthalmol","first-page":"467","article-title":"Spontaneous cerebrospinal fluid leak and idiopathic intracranial hypertension","volume":"30","author":"Tam EK","year":"2019","unstructured":"Tam EK, Gilbert AL. Spontaneous cerebrospinal fluid leak and idiopathic intracranial hypertension. Curr Opin Ophthalmol. 2019;30(6):467\u2013471. doi:10.1097\/ICU.0000000000000603"},{"issue":"4","key":"b3","series-title":"J Neuroophthalmol","first-page":"330","article-title":"Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension","volume":"33","author":"P\u00e9rez MA","year":"2013","unstructured":"P\u00e9rez MA, Bialer OY, Bruce BB, Newman NJ, Biousse V. Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension. J Neuroophthalmol. 2013;33(4):330\u2013337. doi:10.1097\/WNO.0b013e318299c292"},{"key":"b4","series-title":"Case Rep Neurol Med","first-page":"1828461","article-title":"A rare case of spontaneous pneumocephalus associated with nontraumatic cerebrospinal fluid leak","volume":"2016","author":"Baba M","year":"2016","unstructured":"Baba M, Tarar O, Syed A. A rare case of spontaneous pneumocephalus associated with nontraumatic cerebrospinal fluid leak. Case Rep Neurol Med. 2016;2016:1828461. doi:10.1155\/2016\/1828461"},{"issue":"12","key":"b5","series-title":"Ann Otol Rhinol Laryngol","first-page":"902","article-title":"Risk of meningitis with cerebrospinal fluid rhinorrhea","volume":"116","author":"Daudia A","year":"2007","unstructured":"Daudia A, Biswas D, Jones NS. Risk of meningitis with cerebrospinal fluid rhinorrhea. 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Spontaneous cerebrospinal fluid leak and idiopathic intracranial hypertension. Curr Opin Ophthalmol. 2019;30(6):467\u2013471. doi:10.1097\/ICU.0000000000000603"},{"issue":"4","key":"b3","series-title":"J Neuroophthalmol","first-page":"330","article-title":"Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension","volume":"33","author":"P\u00e9rez MA","year":"2013","unstructured":"P\u00e9rez MA, Bialer OY, Bruce BB, Newman NJ, Biousse V. Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension. J Neuroophthalmol. 2013;33(4):330\u2013337. doi:10.1097\/WNO.0b013e318299c292"},{"key":"b4","series-title":"Case Rep Neurol Med","first-page":"1828461","article-title":"A rare case of spontaneous pneumocephalus associated with nontraumatic cerebrospinal fluid leak","volume":"2016","author":"Baba M","year":"2016","unstructured":"Baba M, Tarar O, Syed A. A rare case of spontaneous pneumocephalus associated with nontraumatic cerebrospinal fluid leak. Case Rep Neurol Med. 2016;2016:1828461. doi:10.1155\/2016\/1828461"},{"issue":"12","key":"b5","series-title":"Ann Otol Rhinol Laryngol","first-page":"902","article-title":"Risk of meningitis with cerebrospinal fluid rhinorrhea","volume":"116","author":"Daudia A","year":"2007","unstructured":"Daudia A, Biswas D, Jones NS. Risk of meningitis with cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol. 2007;116(12):902\u2013905. doi:10.1177\/000348940711601206"},{"issue":"5","key":"b6","series-title":"Laryngoscope Investig Otolaryngol","first-page":"215","article-title":"Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review","volume":"2","author":"Lobo BC","year":"2017","unstructured":"Lobo BC, Baumanis MM, Nelson RF. Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review. 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Clinical characteristics of idiopathic intracranial hypertension in older adults. J Neuroophthalmol. 2024;44(4):502\u2013506. doi:10.1097\/WNO.0000000000002055"},{"key":"b19","series-title":"Front Neurol","first-page":"1305972","article-title":"Characterizing a new clinical phenotype: the co-existence of cerebral venous outflow and connective tissue disorders","volume":"14","author":"Midtlien JP","year":"2023","unstructured":"Midtlien JP, Curry BP, Chang E, Kiritsis NR, Aldridge JB, Fargen KM. Characterizing a new clinical phenotype: the co-existence of cerebral venous outflow and connective tissue disorders. 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