Intracranial hypotension with parkinsonism, ataxia, and bulbar weakness.
OBJECTIVE
To describe a case of spontaneous intracranial hypotension with a previously unreported constellation of presenting features.


METHODS
Case report.


METHODS
Tertiary care center.


RESULTS
We describe a patient with intracranial hypotension who presented with a parkinsonian syndrome and later development of ataxia and prominent bulbar symptomatology. Headache was not a feature of her initial presentation and was only reported after repeated questioning during later evaluations. Magnetic resonance imaging of the patient's head revealed findings characteristic of intracranial hypotension. An [18F]fluoro-m-tyrosine positron emission tomographic scan showed normal striatal activity, suggesting intact presynaptic nigrostriatal function. Opening pressure on lumbar puncture was reduced at 40 mm H2O. A source of cerebrospinal fluid leakage was not identified on nuclear cisternography and the patient underwent lumbar epidural blood patching, which resulted in complete resolution of her signs and symptoms as well as in a marked improvement in her imaging findings.


CONCLUSIONS
The clinical spectrum of intracranial hypotension can be broadened to include parkinsonism, cerebellar ataxia, and prominent bulbar dysfunction. As with more common manifestations of the disorder, these features may resolve after appropriate treatment.
Division of Neurology, Toronto Western Hospital, Ontario, Canada.
A S
AS
Pakiam
C
C
Lee
A E
AE
Lang
D001259:Ataxia / Q000150:complications* / Q000175:diagnosis; D001921:Brain / Q000473:pathology*; D010244:Bulbar Palsy, Progressive / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000175:diagnosis; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D012720:Severity of Illness Index