Spontaneous intracranial hypotension: case report with subdural hematomas, steroid dependency and clinical improvement after myelography.
OBJECTIVE
In spontaneous intracranial hypotension (SIH), also known as spontaneous hypoliquorrhea, an abnormally low intracranial pressure leads to posture-dependent headaches similar to those observed after lumbar puncture. Although its etiology is not yet fully understood, it is now diagnosed more often as clinical awareness increases and the availability of MRI becomes more widespread.


METHODS
We report the case of a 42-year-old patient with SIH who developed bilateral subdural hematomas (SDH) and symptomatic diencephalic herniation requiring surgical evacuation. Remarkably, he also developed partial pituitary insufficiency.


METHODS
After SDH was evacuated twice without success, his symptoms resolved rapidly after a diagnostic myelography.


CONCLUSIONS
Besides the orthostatic headache, the possible clinical manifestations are numerous. Serious complications and situations may occur that need to be recognized and treated. In addition to presentation of the case the literature to date is reviewed and discussed.
Platz
J
J
Neurochirurgische Klinik, Universitätsspital Basel, Basel, Switzerland. johannes.platz@web.de
Glücker
T
T
Gratzl
O
O
Woydt
M
M
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004569:Electroencephalography; D004677:Encephalocele / Q000503:physiopathology; D006261:Headache / Q000209:etiology; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology; D019585:Intracranial Hypotension / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D009192:Myelography; D013256:Steroids / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D000893:Anti-Inflammatory Agents; D013256:Steroids