Spontaneous intracranial hypotension presenting as a chronic daily headache

Abstract

A 51-year-old male was referred by his general practitioner with a 9-month history of chronic daily headache, affecting the frontal and vertex areas of the head. T1-weighted MRI with gadolinium enhancement showed diffuse pachymeningeal enhancement (figures 1 and 2). He subsequently had a lumbar puncture, and the opening pressure was 3.5 cm in the cerebrospinal fluid (CSF), confirming intracranial hypotension. The CSF constituents were normal. When the history was revisited, it was noted that the patient had for the first 2 months postural-related headaches; however, …