Spontaneous intracranial hypotension: headache with a reversible Arnold-Chiari malformation.
Spontaneous intracranial hypotension is characterized by severe postural headache in the setting of low CSF pressure, usually attributed to a cryptic CSF leak. We report a patient whose prolonged refractory headache was characterized by the clinical symptoms of occipital neuralgia, but was also associated with the radiographic appearance of an Arnold-Chiari malformation, type I and low CSF pressure. After extensive diagnostic evaluation, CT cisternomyelography ultimately demonstrated a CSF leak at the C2 vertebral level. Symptomatic relief was sustained only with long-term theophylline administration. The apparent Arnold-Chiari malformation resolved with treatment of the low CSF pressure.
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
S E
SE
Kasner
J
J
Rosenfeld
R E
RE
Farber
D000328:Adult; D001139:Arnold-Chiari Malformation / Q000150:complications*; D015170:Cerebrospinal Fluid Pressure; D005260:Female; D006261:Headache / Q000209:etiology* / Q000503:physiopathology; D006801:Humans