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Case of spontaneous intracranial hypotension: clinical, neuroimaging and treatment approach
  1. Govinda Siripurapu,
  2. Awadh Kishor Pandit,
  3. Divya M Radhakrishnan and
  4. Achal Kumar Srivastava
  1. Neurology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Awadh Kishor Pandit; akpandit.med{at}gmail.com

Abstract

A woman in her 40s presented with a 3-month history of intermittent bilateral daily headache of moderate intensity. She had severe headaches for almost 1 month prior to the presentation, which was aggravated by standing and relieved by lying down. She underwent a non-contrast CT of the head followed by MRI of the brain and spine. Neuroimaging of the brain showed features of intracranial hypotension and spine MRI myelography fast imaging employing steady state acquisition sequences confirmed the site of cerebrospinal fluid (CSF) leak. An epidural blood patch (EBP) was placed to close the CSF leakage site. She had significant improvement in her symptoms and repeat MRI at 4 weeks of follow-up showed resolution of imaging abnormalities. She became symptom-free without the requirement of additional EBP. Our report highlights the importance of suspecting and evaluating spontaneous intracranial hypotension in a patient presented with a typical orthostatic headache. Early intervention and keeping a low threshold for evaluation based on a few early clinical and imaging clues can lead to successful management of such cases.

  • Pain (neurology)
  • Headache (including migraines)
  • Neurology

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Footnotes

  • Twitter @sgovinda87

  • Contributors GS contributed in writing the case report. AKP and AKS contributed in reviewing and modifying for better presentation. DMR contributed in investigations and images selection.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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