{"id":{"repo_id":"utswmed","oai_identifier":"oai:utswmed-ir.tdl.org:2152.5/10845"},"canonical_url":"https://search.dev.ndltd.org/etd/utswmed/oai:utswmed-ir.tdl.org:2152.5/10845","repository":{"repo_id":"utswmed","name":"University of Texas Southwestern Medical Center","base_url":"https://utswmed-ir.tdl.org/server/oai/request"},"display":{"title":"Quality of Life in Patients With Confirmed and Suspected Spinal CSF Leaks","abstract":"The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","abstract_html":"The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","abstract_has_math":false,"creators":["Liaw, Victor"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Friedman, Deborah I.","Doyle, Alexander G.","Khan, Shaida"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026-06-15T19:57:14Z","date_published":"2026-06-15T19:57:14Z","updated_at":"2026-07-24T05:52:22Z","subjects":["Activities of Daily Living","Headache","Intracranial Hypotension","Quality of Life"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["1596185276"],"render_values":[{"text":"1596185276","href":null,"code":true}]}]},"links":{"outbound_url":"https://hdl.handle.net/2152.5/10845","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Friedman, Deborah I.","Doyle, Alexander G.","Khan, Shaida"]},{"key":"dc:creator","label":"Author","values":["Liaw, Victor"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026-06-15T19:57:14Z","2024-05","May 2024"]},{"key":"dc:type","label":"Dc Type","values":["Thesis","text"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Activities of Daily Living","Headache","Intracranial Hypotension","Quality of Life"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://hdl.handle.net/2152.5/10845","1596185276"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","BACKGROUND: Spontaneous intracranial hypotension (SIH) can occur secondary to a spinal cerebrospinal fluid (CSF) leak or CSF-venous fistula. Presently, SIH is commonly underdiagnosed and misdiagnosed due to imperfect diagnostic criteria and spinal imaging techniques. Patients who fail conservative management or epidural blood patches currently have limited treatment options. Few studies have documented the impact of SIH on patient quality of life (QoL). OBJECTIVE: The purpose of this present study is to assess QoL in SIH using validated questionnaires as well as pilot the 'SIH Impact Inventory', a novel SIH-specific survey instrument. METHODS: We performed a cross-sectional survey of patients with SIH seen at the Headache and Facial Pain Program at the University of Texas Southwestern (UTSW) from 2016 to 2022. Using an online data collection tool (REDCAP V 11.2.2), participants completely validated questionnaires assessing general well-being (SF-36), depression (PHQ-9), general anxiety disorder-7 (GAD-7), spiritual well-being during chronic therapy (FACIT-Sp-12), headache impact (HIT-6), and the SIH Impact Inventory. Subsequently, we interviewed willing participants to administer the Columbia-Suicide Severity Rating Scale (C-SSRS) assessing suicidal behavior and ideation. RESULTS: 234 patients met inclusion criteria and were invited to participate in the study. 98 patients completed all self-administered questionnaires including the SIH Impact Inventory, and 67 completed the C-SSRS. The average age of the cohort was 50.6 years (SD: 15.7), predominantly female (69.4%), White (90.8%), and married or common-law (71.4%). Three-quarters (74.5%) scored within the most severe headache category (HIT-6). SF-36 scores were significantly inferior (p < 0.0001) to the general population and lower than reported values for patients with multiple sclerosis and idiopathic intracranial hypertension. Almost half (49.1%) of respondents scored in the moderate depression range or worse (>10), and 25.4% scored with moderate anxiety or worse (>10). FACIT-Sp-12 scores were significantly worse (p < 0.0001) in symptomatic participants than in the validation cohorts of patients with AIDS and cancer. Of the 67 respondents who completed the C-SSRS, more than half (64.2%) endorsed a wish to be dead, and 22.4% had demonstrated suicidal behavior. Patients with symptom-free SIH (n = 22) scored significantly better than symptomatic patients, comparable with the general population. CONCLUSION: Based on our single-center cohort, SIH is associated with severe headache pain and high rates of depression, anxiety, and disability, affecting basic activities of daily living. Individuals with confirmed and suspected spinal CSF leaks scored similarly on these measures including suicidality. Outcomes were comparable with the general population after successful treatment or spontaneous remission. Improved identification and treatment of SIH are imperative to improve patients' QoL."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Quality of Life in Patients With Confirmed and Suspected Spinal CSF Leaks"]}]}],"canonical_facts":{"dc:contributor":["Friedman, Deborah I.","Doyle, Alexander G.","Khan, Shaida"],"dc:creator":["Liaw, Victor"],"dc:date":["2026-06-15T19:57:14Z","2024-05","May 2024"],"dc:description":["The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.","BACKGROUND: Spontaneous intracranial hypotension (SIH) can occur secondary to a spinal cerebrospinal fluid (CSF) leak or CSF-venous fistula. Presently, SIH is commonly underdiagnosed and misdiagnosed due to imperfect diagnostic criteria and spinal imaging techniques. Patients who fail conservative management or epidural blood patches currently have limited treatment options. Few studies have documented the impact of SIH on patient quality of life (QoL). OBJECTIVE: The purpose of this present study is to assess QoL in SIH using validated questionnaires as well as pilot the 'SIH Impact Inventory', a novel SIH-specific survey instrument. METHODS: We performed a cross-sectional survey of patients with SIH seen at the Headache and Facial Pain Program at the University of Texas Southwestern (UTSW) from 2016 to 2022. Using an online data collection tool (REDCAP V 11.2.2), participants completely validated questionnaires assessing general well-being (SF-36), depression (PHQ-9), general anxiety disorder-7 (GAD-7), spiritual well-being during chronic therapy (FACIT-Sp-12), headache impact (HIT-6), and the SIH Impact Inventory. Subsequently, we interviewed willing participants to administer the Columbia-Suicide Severity Rating Scale (C-SSRS) assessing suicidal behavior and ideation. RESULTS: 234 patients met inclusion criteria and were invited to participate in the study. 98 patients completed all self-administered questionnaires including the SIH Impact Inventory, and 67 completed the C-SSRS. The average age of the cohort was 50.6 years (SD: 15.7), predominantly female (69.4%), White (90.8%), and married or common-law (71.4%). Three-quarters (74.5%) scored within the most severe headache category (HIT-6). SF-36 scores were significantly inferior (p < 0.0001) to the general population and lower than reported values for patients with multiple sclerosis and idiopathic intracranial hypertension. Almost half (49.1%) of respondents scored in the moderate depression range or worse (>10), and 25.4% scored with moderate anxiety or worse (>10). FACIT-Sp-12 scores were significantly worse (p < 0.0001) in symptomatic participants than in the validation cohorts of patients with AIDS and cancer. Of the 67 respondents who completed the C-SSRS, more than half (64.2%) endorsed a wish to be dead, and 22.4% had demonstrated suicidal behavior. Patients with symptom-free SIH (n = 22) scored significantly better than symptomatic patients, comparable with the general population. CONCLUSION: Based on our single-center cohort, SIH is associated with severe headache pain and high rates of depression, anxiety, and disability, affecting basic activities of daily living. Individuals with confirmed and suspected spinal CSF leaks scored similarly on these measures including suicidality. Outcomes were comparable with the general population after successful treatment or spontaneous remission. Improved identification and treatment of SIH are imperative to improve patients' QoL."],"dc:format":["application/pdf"],"dc:identifier":["https://hdl.handle.net/2152.5/10845","1596185276"],"dc:language":["en"],"dc:subject":["Activities of Daily Living","Headache","Intracranial Hypotension","Quality of Life"],"dc:title":["Quality of Life in Patients With Confirmed and Suspected Spinal CSF Leaks"],"dc:type":["Thesis","text"]},"updated_at":"2026-07-24T05:52:22Z"}