title: Spontaneous intracranial hypotension complicated by malignancyinduced disseminated intravascular coagulation: A case report.
abstract: OBJECTIVE
  Spontaneous intracranial hypotension (SIH) is a rare type of headache. The association of SIH with malignancy and disseminated intravascular coagulation (DIC) has not previously been reported.
  
  
  METHODS
  A 60-year-old woman had orthostatic headache for more than one month before admission. MRI of brain showed diffuse pachymeningeal enhancement with bilateral subdural hematoma. MR myelography revealed epidural fluid collection and possible CSF leakage at the level of C5 to C6. DIC due to carcinoma of unknown origin was found based on evidence of malignant pleural effusion and multiple bone metastases. After correction of coagulopathy, the patient received an epidural blood patch. Unfortunately, follow-up brain MRI showed disease progression. The patient died of acute respiratory failure four weeks after admission.
  
  
  CONCLUSIONS
  This is the first case report of an association between SIH and DIC due to malignancy. Further case studies are needed to provide further support of this association.
authors.affiliation: Department of Neurology, Neurological Institute; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
authors.forename: Shu-Shya
authors.initials: SS
authors.lastname: Hseu
authors.affiliation: Department of Neurology, Neurological Institute; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Chen
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
authors.forename: Jiing-Feng
authors.initials: JF
authors.lastname: Lirng
authors.affiliation: Department of Neurology, Neurological Institute; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
authors.forename: Yen-Feng
authors.initials: YF
authors.lastname: Wang
authors.affiliation: Department of Neurology, Neurological Institute; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Department of Neurology, Neurological Institute; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
authors.forename: Jong-Ling
authors.initials: JL
authors.lastname: Fuh
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000556:secondary; D001859:Bone Neoplasms / Q000150:complications* / Q000556:secondary; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000209:etiology; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged