SHM Converge Scientific Abstract ePoster Gallery-It's in the Position- A Case of Spontaneous Intracranial Hypotension

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This case describes a 41-year-old woman with hypertension, hyperlipidemia, morbid obesity, and prediabetes who developed six weeks of daily frontal, pressure-like headaches that worsened when standing and were associated with nausea and vomiting. Because her symptoms improved minimally with over-the-counter pain medications, brain MRI was obtained and showed thin diffuse chronic-appearing subdural collections, raising concern for intracranial hypotension.<br /><br />Further evaluation with MRI of the complete spine demonstrated extradural fluid in the cervical canal, posterior fossa, thoracic spine, and lumbar spine, suggesting cerebrospinal fluid (CSF) leakage but without an obvious source. Neurosurgery was consulted, and CT myelography identified extradural contrast leaking into the left neural foramina from L1 to L4, most prominently at L3-L4, with frank extravasation into the paraspinal soft tissues near the left psoas muscle. This confirmed the site of CSF leak and supported the diagnosis of spontaneous intracranial hypotension (SIH).<br /><br />The patient underwent a lumbar epidural blood patch, which she tolerated well and which led to significant improvement in her headaches.<br /><br />The discussion emphasizes that SIH is an uncommon cause of secondary headache due to low CSF volume from a dural tear. Typical symptoms include orthostatic headache, nausea, vomiting, visual changes, vertigo, and tinnitus. MRI with contrast is key for diagnosis, while CT myelography is often needed to localize the leak. If untreated, SIH can cause serious complications such as subdural hemorrhage, subarachnoid hemorrhage, dural sinus thrombosis, cranial nerve palsies, and coma. Early recognition of positional headaches and other red flags is crucial to avoid delayed diagnosis and reduce morbidity.

Asset Subtitle

Danielle J.R Pope

Meta Tag

Author List Danielle J.R Pope, Jaehwan Jung, Sofia Terner, Zachary Banbury

Category Clinical Vignettes

Concept Spontaneous Intracranial Hypotension

Concept Orthostatic Headache

Concept Spinal CSF Leak

Concept Secondary Headache

Concept Magnetic Resonance Imaging

Distinguished Non-Finalist

Presenter Organization Englewood Health

Presenting Author Danielle J.R Pope

Track Adult

Keywords

spontaneous intracranial hypotension

orthostatic headache

cerebrospinal fluid leak

subdural collections

MRI spine

CT myelography

epidural blood patch

dural tear

nausea and vomiting

intracranial hypotension

Spontaneous Intracranial Hypotension

Orthostatic Headache

Spinal CSF Leak

Secondary Headache

Magnetic Resonance Imaging