Two Cases of Spontaneous Intracranial Hypotension

Abstract

Spontaneous intracranial hypotension(SIH) is a rare syndrome which causes postural headaches associated with low CSF pressure. Headaches are usually accompanied by on rare occasions diplopia, and transient visual obscuration as well as nausea, vomiting, tinnitus, neck stiffness, vertigo, photophobia, and phonophobia. CSF leakage from a spinal meningeal defect may be the most common cause of this syndrome. Downward sagging of the brain due to lw CSF pressure may produce headaches by traction of intracranial and meningeal pain-sensitive structures. Lumbar puncture reveals low opening pressure. CSF protein and cell count may be slightly elevated. Brain and cervical MRI may show diffuse and continuous pachymeningeal enhancement with gadolinium, subdural effusion, or downward displacement of the brain. We present two patients with SIH, in whom epidural blood patch produced an immediate and complete resolution of the symptoms. We couldn't identify CSF leakage site in either of them.