Characteristics of Patients With Bibrachial Amyotrophy Due to Spontaneous Spinal CSF Leaks

BACKGROUND AND OBJECTIVES: Spontaneous spinal CSF leaks cause intracranial hypotension (SIH) and may be complicated by bibrachial amyotrophy (BBA), but the clinical and radiographic features of this complication are not well characterized. The objective of this study was to identify the unique characteristics and outcomes of treatment in patients with SIH and BBA. METHODS: In this case-control study of patients with SIH complicated by BBA, 2 matched controls were selected per patient based on type of underlying leak (ventral vs lateral) and year of encounter. The patients were evaluated at a quaternary referral center between January 1, 2001, and June 30, 2024. RESULTS: = 0.007). DISCUSSION: BBA due to SIH is rare, typically affects men, occurs years after SIH symptom onset, and is associated with a thick anterior extradural CSF collection on MRI. Our data suggest that surgical repair is low risk, durable, and should arrest or reverse motor impairment if performed within 10 years of BBA symptom onset, but more rigorous study designs are needed to address outcomes in these patients.