Spontaneous Intracranial Hypotension in the Postpartum Period: A Case Report

Spontaneous intracranial hypotension (SIH) is characterized by an orthostatic variation in headache precipitation.The typical history connotes headaches that are triggered by an upright posture and partially or completely relieved in the supine decubitus. In most patients, the site of cerebrospinal fluid (CSF) leak is at the cervical or thoracic spinal level. The imaging modalities needed to establish the diagnosis of SIH include computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, CT, and MRI myelography, and radionuclide cisternography. Treatment usually consists of conservative measures of prolonged bedrest in the supine decubitus over a few weeks. However, patients unresponsive to such measures are treated by an autologous epidural blood patch (EBP) administration at the site of CSF leak. We describe an unusual patient who developed SIH due to vigorous bearing down efforts during childbirth resulting in dural tear at cervical spine level and who was treated with a minimally invasive percutaneous image guided epidural blood patch using freshly drawn autologous blood with a very rewarding outcome.