A case report on spontaneous intracranial hypotension

Abstract

A 38-year-old lady with bronchial asthma, psychiatric illness, and a suicidal attempt 6 years ago presented with persistent headache for more than 2 weeks. She was diagnosed with recurrent sinusitis and migraine and was on treatment at a local hospital and referred to a higher center for persistent headache which was orthostatic in nature. Clinically, the patient was alert, oriented, and systemic examination was unremarkable. MRI spine showed extensive extradural collection separating the anterior dural sac from the bony canal extending from C3 to D1. CT Myelogram showed cervical dural leak anteriorly at C7-D1 and bony osteophyte impinging on the dural sac – likely cause of leak. Diagnosis of Spontaneous Intracranial Hypotension was made. As no improvement was noted with trial of conservative management, we proceeded with advanced imaging-guided Epidural blood patch repair, following which the symptoms improved.