title: Headache in cerebrospinal fluid volume depletion syndrome: a case report.
abstract: Cerebrospinal fluid (CSF) volume depletion syndrome is due to leakage of cerebrospinal fluid through lesions of the dural sac at the level of the cranial base or of the spine. When past medical history is negative for recent trauma or surgery, the term spontaneous intracranial hypotension (SIH) is used. SIH is characterized clinically by orthostatic headache, neck pain, nausea, emesis, horizontal diplopia, tinnitus, plugged ear, hearing difficulties, blurring of vision, facial numbness, and upper limb radicular symptoms. In SIH, brain and cervical MR scans show a diffuse pachymeningeal gadolinium enhancement that ends at the site of CSF leakage. The application of epidural blood patches has been proposed as an effective therapy for SIH. Here we describe a case of SIH with very unusual headache features; the patient reported a paradoxical pattern of postural headache provoked by clinostatic position. The CSF leakage was identified at the convexity of the skull and headache disappeared following treatment with fluid, analgesics and steroids.
authors.affiliation: Department of Neurology, Otorhinolaryngology, Ophthalmology and Psychiatry, University of Palermo, Italy.
authors.forename: Innocenzo
authors.initials: I
authors.lastname: Lupo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Salemi
authors.forename: Brigida
authors.initials: B
authors.lastname: Fierro
authors.forename: Filippo
authors.initials: F
authors.lastname: Brighina
authors.forename: Ornella
authors.initials: O
authors.lastname: Daniele
authors.forename: Aurelio
authors.initials: A
authors.lastname: Caronia
authors.forename: Valentina
authors.initials: V
authors.lastname: Saia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Savettieri
mesh_terms: D015170:Cerebrospinal Fluid Pressure; D006261:Headache / Q000134:cerebrospinal fluid / Q000209:etiology*; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012887:Skull Fractures / Q000134:cerebrospinal fluid / Q000150:complications*; D013577:Syndrome; D016896:Treatment Outcome