Spontaneous Intracranial Hypotension with Cerebrospinal Fluid Leakage at 2 Sites Treated by Epidural Blood Patch
Ching-Hsiung Liu；Szu-Chia Lai；Ching-Shiung Lin；Huey-Yi Hung；Ming-Tsung Chen
orthostatic headache ； intracranial hypotension ； magnetic resonance imaging ； cisternography ； blood patch
Acta Neurologica Taiwanica
|Volume or Term/Year and Month of Publication||
20卷4期（2011 / 12 / 01）
272 - 276
Purpose: Spontaneous intracranial hypotension (SIH) is a relatively uncommon cause of headache, which usually presents as orthostatic cranial pain and is relieved by recumbency. The precise cause of spontaneous spinal cerebrospinal fluid leakage related SIH remains unknown.Case Report: We report the case of a 32-year-old man who presented with an orthostatic headache. Brain magnetic resonance imaging (MRI) revealed typical pachymeningeal enhancement. Radionuclide cisternography revealed leakages in the cervicothoracic and upper cervical areas. The patient was successfully treated by lumbar epidural blood patch (EBP).Conclusion: The diagnosis of SIH involves the assessment of the characteristic clinical presentations and non-invesive neuroimaging studies. The latest diagnostic criteria with more broadened spectrum due to variable manifestations are discussed. EBP is an effective treatment for SIH if conservative management fails.