Spontaneous intracranial hypotension – case report

Klinika Neurologii i Epileptologii II Katedry Chorób Układu Nerwowego Uniwersytetu Medycznego w Łodzi

AKTUALN NEUROL 2010, 10 (2), p. 100-104
ABSTRACT

The syndrome of spontaneous intracranial hypotension (SIH) was first described in 1938 and was considered a rare disorder. Because all of SIH occur secondary to spontaneous spinal cerebrospinal fluid (CSF) leak, the term: spontaneous spinal CSF leak is the preferred descriptive term. Recent evidence suggest that SIH is not rare but underdiagnosed. The spectrum of clinical and radiological manifestations is varied. The orthostatic headache and opening pressure of cerebrospinal fluid (CSF) under 60 mm H2O are cardinal diagnostic features. Treatment consist in bed rest, oral hydration, caffeine or theophylline intake, epidural blood patching, percutaneous fibrin glue injection or surgical CSF leak repair. The effectiveness of those treatment is limited and poorly studied. Author present case of 19-year-old woman with 2 days history of headache, tinnitus and photophobia. On neurologic examination patient presented only vertical diplopia. CT of head showed swelling of brain and contractions of cerebral ventricles. A lumbar puncture on the day after admission excluded neuroinfection and subarachnoid haemorrhage. The CSF opening pressure was 15 mm H2O. An MRI of cervical, thoracic and lumbar spine did not show any potential structures connected with CSF leak. Myelo-CT showed in lumbar region four places of CSF leak. This case demonstrates some of the potential diagnostic difficulties and unusual cause for sudden onset headache.

Keywords: spontaneous intracranial hypotension, spontaneous spinal cerebrospinal fluid leak, orthostatic headache, diagnosis, treatment