Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture.
BACKGROUND
Spontaneous intracranial hypotension is an infrequent cause of secondary headache due to cerebrospinal fluid (CSF) hypovolemia.


OBJECTIVE
To describe a case of headache revealing spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture.


METHODS
A 34-year-old man presented with acute postural headache. The first cerebral computed tomography scan was normal. Lumbar puncture showed hyperproteinorachy at 2 g/L with six lymphocytic cells. The headache became very intense. At admission, clinical examination was normal. Ophthalmological examination did not show any abnormalities. Encephalic magnetic resonance imaging (MRI) showed bilateral subdural hematoma with tonsillar descent simulating Chiari type I malformation. After surgical drainage and symptomatic treatment, the patient was discharged with no recurrence.


CONCLUSIONS
Spontaneous intracranial hypotension is associated with simple clinical presentation, orthostatic headache, and characteristic MRI findings. Misdiagnosed, it leads to unnecessary procedures.
Neurology Department, University Hospital of Mohammed the VI , Cadi Ayyad University, Marrakech, Morocco.
Nissrine
N
Louhab
Neurology Department, University Hospital of Mohammed the VI , Cadi Ayyad University, Marrakech, Morocco.
Nawal
N
Adali
Neurosurgery Department, University Hospital of Mohammed the VI , Cadi Ayyad University, Marrakech, Morocco.
Mehdi
M
Laghmari
Neurosurgery Department, University Hospital of Mohammed the VI , Cadi Ayyad University, Marrakech, Morocco.
Wafae El
WE
Hymer
Neurosurgery Department, University Hospital of Mohammed the VI , Cadi Ayyad University, Marrakech, Morocco.
Said Ait
SA
Ben Ali
Neurology Department, University Hospital of Mohammed the VI , Cadi Ayyad University, Marrakech, Morocco.
Najib
N
Kissani
headache; intracranial hypotension; magnetic resonance imaging