Spontaneous intracranial hypotension with cerebrospinal fluid leakage at 2 sites treated by epidural blood patch.
OBJECTIVE
Spontaneous intracranial hypotension (SIH) is a relatively uncommon cause of headache, which usually presents as orthostatic cranial pain and is relieved by recumbency. The precise cause of spontaneous spinal cerebrospinal fluid leakage related SIH remains unknown.


METHODS
We report the case of a 32-year-old man who presented with an orthostatic headache. Brain magnetic resonance imaging (MRI) revealed typical pachymeningeal enhancement. Radionuclide cisternography revealed leakages in the cervicothoracic and upper cervical areas. The patient was successfully treated by lumbar epidural blood patch (EBP).


CONCLUSIONS
The diagnosis of SIH involves the assessment of the characteristic clinical presentations and non-invesive neuroimaging studies. The latest diagnostic criteria with more broadened spectrum due to variable manifestations are discussed. EBP is an effective treatment for SIH if conservative management fails.
Department of Neurology, Lotung Poh-Ai Hospital, Ilan, Taiwan. chl@mail.pohai.org.tw
Ching-Hsiung
CH
Liu
Szu-Chia
SC
Lai
Ching-Shiung
CS
Lin
Huey-Yi
HY
Hung
Ming-Tsung
MT
Chen
D000328:Adult; D017217:Blood Patch, Epidural; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000628:therapy*; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed