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

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Spontaneous intracranial hypotension (SIH) is a significant cause of daily headaches, particularly in young to middle-aged active individuals.
• Misdiagnosis of SIH can lead to prolonged patient inactivity and substantial healthcare expenditures.
• Accurate diagnosis necessitates a high index of clinical suspicion and meticulous interpretation of neuroimaging studies.

Observation:

• A challenging case of SIH is presented, highlighting diagnostic difficulties that mimicked cerebro-vascular disease, meningitis, and granulomatous diseases.
• Initial therapeutic attempts for the presented case exacerbated the patient's condition, underscoring the need for precise diagnosis.
• The patient's condition improved significantly after the correct diagnosis of SIH was established and appropriate treatment was initiated.

Findings:

• SIH is characterized by orthostatic headaches, often accompanied by other neurological symptoms.
• Cerebrospinal fluid (CSF) volume loss due to a spinal CSF leak is the primary pathophysiology.
• Characteristic findings on MRI include pachymeningeal enhancement, sagging of the brain, and enlarged dural veins.

Implications:

• Raising awareness of SIH is critical for timely diagnosis and effective management.
• Improved diagnostic strategies and treatment protocols for SIH can reduce patient morbidity and healthcare burden.
• This case underscores the importance of considering SIH in the differential diagnosis of daily headaches, even in the presence of atypical presentations.