SPONTANEOUS INTRATHECAL HYPOTENSION

CASE REPORT

Abstract

Introduction: Intracranial hypotension is a condition characterized by a lower than normal volume of cerebrospinal fluid (CSF) due to CSF leakage across the dural membrane in one or multiple locations. Symptoms include orthostatic headache and symptoms associated with stiff neck, tinnitus, photophobia, nausea, and evidence of low CSF pressure or leakage through at least one imaging modality. Case report: male patient, 46 years old, physician, with report of spontaneous CSF leak during physical activity. It evolved with the following symptoms: pulsatile holocranial headache that worsens when lying down and getting up. He underwent oral treatment without success, requiring an invasive procedure such as a blood patch to improve symptoms. After a few days he underwent new imaging tests with no changes. Discussion: The most common site of CSF leak is the cervicothoracic junction or upper thoracic region. Epidural blood patches are frequently performed for the treatment of post-dural puncture headache, which may vary between the previous site of cerebrospinal fluid leak or the lumbar location.