What are your thoughts about a previous history of meningitis (viral, bacterial, other) in some spontaneous spinal CSF leakers? Could meningitis result in dural weakness?
Most forms of meningitis are actually risk factors for the development of intracranial hypertension, because the inflammation caused by meningitis interferes with the pathways of CSF absorption. However, it is certainly possible that some specific pathogens can cause dural weakness. When a spinal tap shows an increase of white blood cells in the CSF which is also a common finding in CSF leak, a diagnosis of meningitis is often made erroneously in patients with spontaneous intracranial hypotension. I have seen a few patients that have a diagnosis of Lyme disease but we have not identified a relationship between Lyme disease and spontaneous CSF leaks.