[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-450927-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-450927-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","resolution-of-hypertension-symptoms-following-cerebrospinal-fluid-leak-with-acetazolamide-a-case-report","Resolution of Hypertension Symptoms Following Cerebrospinal Fluid Leak With Acetazolamide - A Case Report","","Paradoxical intracranial hypertension (ICH) can emerge after cerebrospinal fluid (CSF) leak resolution from spine surgery, even though intracranial hypotension is the more expected outcome. This case report describes two patients with chronic post-leak headaches and accompanying ICH-indicative symptoms, including tinnitus, visual disturbances, and dizziness. Both were treated with a 4-week acetazolamide regimen followed by a 4-week taper, leading to near-complete symptom relief and successful discontinuation.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/resolution-of-hypertension-symptoms-following-cerebrospinal-fluid-leak-with-acetazolamide-a-case-report/450927/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/resolution-of-hypertension-symptoms-following-cerebrospinal-fluid-leak-with-acetazolamide-a-case-report/450927.png","ImageObject",300,407,{"name":42,"@type":43},"Melati","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What complication is described after spine surgery and CSF leak repair?","Question",{"text":63,"@type":64},"The report focuses on paradoxical intracranial hypertension (ICH) developing after cerebrospinal fluid (CSF) leak resolution and dural healing.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What symptoms in the two cases suggested ICH?",{"text":68,"@type":64},"Both patients reported tinnitus and visual changes closely aligned with headache symptoms, with headaches showing atypical patterns consistent with intracranial hypertension.",{"name":70,"@type":61,"acceptedAnswer":71},"How was acetazolamide used and what was the outcome?",{"text":72,"@type":64},"Patients received acetazolamide for 4 weeks, followed by a tapering period of 4 weeks; both experienced near-complete relief and were successfully weaned off.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},450927,1790766252,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Resolution of hypertension symptoms following cerebrospinal fluid leak with acetazolamide: a case report  \nElizabeth Raulston, Maya Bhutwala, Kyle Kesler  \nCenter for Sports Medicine and Orthopaedics, Chattanooga, TN, USA  \nContributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \nCorrespondence to: Elizabeth Raulston, MS. Center for Sports Medicine and Orthopaedics, 2415 McCallie Avenue, Chattanooga, TN 37404, USA.  \n[Email: Eraulston@sportmed.com](Email: Eraulston@sportmed.com).  \nBackground: Incidental durotomy and the subsequent cerebrospinal fluid (CSF) leak are well-recognized complications of spine surgery. While primary repair can be effective, persistent symptomatic leaks may necessitate more advanced interventions, and some patients continue to experience refractory headaches after  \nspine surgery-related CSF leak treatment.  \nCase Description: This case report describes two patients who presented with chronic headaches following CSF leak resolution and symptoms indicative of intracranial hypertension (ICH), including tinnitus, visual disturbances, and dizziness. Case 1 was a 46-year-old male who suffered from a continual lowgrade headache that intensified when lying down, particularly disturbing him during the early hours of the morning. A myelogram revealed excessive intradural pressure. Case 2 was a 55-year-old female who required a temporary lumbar drain as part of her treatment for a persistent CSF leak; she experienced headaches that  \nwere particularly severe at night and worsened with exertion or prolonged activity.  \nConclusions: Both patients reported tinnitus and visual changes closely aligned with headache symptoms.  \nThey were treated for ICH using a 4 weeks regimen of acetazolamide, followed by a tapering period of  \n4 weeks. With the initiation of acetazolamide, both patients experienced near-complete relief from their symptoms and were successfully weaned off. It is hypothesized that both individuals may have developed an overproduction of CSF following their prior leaks, leading to ICH, which effectively mitigated  \nAcetazolamide’s established role in reducing intracranial pressure.  \nKeywords: Spine surgery; case report; intracranial hypertension (ICH); acetazolamide; cerebrospinal fluid (CSF)  \nSubmitted Jun 24, 2025. Accepted for publication Aug 22, 2025. Published online Dec 22, 2025.  \ndoi: 10.21037/jss-25-103  \nView this article at: [https://dx.doi.org/10.21037/jss-25-103](https://dx.doi.org/10.21037/jss-25-103)  \nIntroduction  \nCerebrospinal fluid (CSF) leaks are a known complication of spine surgery, occurring in approximately 1% to 17% of procedures, depending on the complexity and type of surgery performed (1) . While many leaks resolve with primary repair, persistent or recurrent leaks can lead to significant morbidity, including orthostatic headaches and, in rare cases, paradoxical intracranial hypertension (ICH) (2,3) . Although intracranial hypotension is the  \nmore commonly expected consequence of a CSF leak, ICH has been observed following leak resolution and dural healing, possibly due to CSF overproduction or altered CSF dynamics (4) . Symptoms of ICH including headache, visual disturbances, tinnitus, and dizziness may be underrecognized in postoperative spine patients, especially when presenting after a resolved CSF leak (5) . Acetazolamide, a carbonic anhydrase inhibitor, is used in the management of ICH as it reduces CSF production by inhibiting carbonic anhydrase in the choroid plexus and has  \n© AME Publishing Company. J Spine Surg 2025;11(4):1126-1131 | [https://dx.doi.org/10.21037/jss-25-103](https://dx.doi.org/10.21037/jss-25-103)  \nJournal of Spine Surgery, Vol 11, No 4 December 2025 1127","cbCaid8Zdr4HsJ39","https://ap.wps.com/l/cbCaid8Zdr4HsJ39","pdf",2412261,"English","# Introduction\n# Case presentation\n## Case summary 1\n## Case summary 2\n# Highlight box\n## Key findings\n## What is known and what is new?\n## What is the implication, and who should change now? \n# Conclusions","[{\"question\":\"What complication is described after spine surgery and CSF leak repair?\",\"answer\":\"The report focuses on paradoxical intracranial hypertension (ICH) developing after cerebrospinal fluid (CSF) leak resolution and dural healing.\"},{\"question\":\"What symptoms in the two cases suggested ICH?\",\"answer\":\"Both patients reported tinnitus and visual changes closely aligned with headache symptoms, with headaches showing atypical patterns consistent with intracranial hypertension.\"},{\"question\":\"How was acetazolamide used and what was the outcome?\",\"answer\":\"Patients received acetazolamide for 4 weeks, followed by a tapering period of 4 weeks; both experienced near-complete relief and were successfully weaned off.\"}]","Resolution of Hypertension Symptoms Following Cerebrospinal Fluid Leak With Acetazolamide - A Case Report | PDF",1790734091,15]