Spontaneous Intracranial Hypotension: Case Report and Update on Diagnosis and Treatment

Abstract

Spontaneous intracranial hypotension (SIH) is an important cause of daily headaches that occur in young and middle-aged, active persons and is often misdiagnosed, leading to prolonged inactivity and rather high healthcare expenditures. Its diagnosis requires a high degree of clinical suspicion and careful interpretation of imaging studies. We present a case of SIH, which was successfully treated but which posed serious diagnostic challenges, ranging from cerebro-vascular disease and meningitis to granulomatous diseases, and for whom every therapeutic attempt just worsened the patient’s condition until we finally reached the correct diagnosis. To raise awareness of this condition, we also present an updated overview of the clinical picture, evaluation, and treatment options for SIH.

Keywords

• spontaneous intracranial hypotension
• cerebrospinal fluid leak
• diagnostic criteria
• magnetic resonance imaging
• myelography
• epidural blood patch