ArticleHeadache2026
Frequency and characteristics of multi-domain autonomic dysfunction in patients with spontaneous intracranial hypotension.
Article in Headache, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveWe aimed to evaluate multi-domain autonomic function in patients with spontaneous intracranial hypotension (SIH) and investigate its association with clinical and radiological features.
backgroundSIH often presents with orthostatic symptoms that overlap with autonomic disorders; however, the prevalence and distribution of autonomic dysfunction in SIH remain poorly characterized.
methodsIn this cross-sectional study conducted at a tertiary care center in Seoul, Republic of Korea, 34 patients with imaging-confirmed SIH underwent a comprehensive autonomic function testing between October 2024 and February 2025. The autonomic function testing battery included heart rate response to deep breathing, Valsalva maneuver, head-up tilt test, and quantitative sudomotor axon reflex test. Hemodynamic responses during head-up tilt were monitored using both intermittent brachial and continuous beat-to-beat blood pressure measurements. Autonomic abnormalities were determined using age- and sex-matched Korean normative data.
resultsAll enrolled patients presented with extradural fluid collection on spinal magnetic resonance imaging, indicating SIH due to dural tears. Autonomic dysfunction was identified in 18 of 34 (52.9%) of patients in the orthostatic domain, nine of 34 (26.5%) in the cardiovagal domain, and 10 of 34 (29.4%) in the sudomotor domain. Postural orthostatic tachycardia syndrome was the most frequent orthostatic abnormality, observed in 12 of 34 (35.3%) patients, followed by classical orthostatic hypotension in four of 34 (11.8%), syncope in one of 34 (2.9%), and delayed orthostatic hypotension in one of 34 (2.9%). No significant associations were identified between domains of autonomic dysfunction and the clinical or imaging features of SIH in false discovery rate-corrected analyses.
conclusionIn patients with SIH due to dural tears, orthostatic hemodynamic abnormalities were common, with postural orthostatic tachycardia syndrome being the most frequent phenotype.
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