Intracranial hypotension: An uncommon entity with common presentation

Abstract

Headache disorders are among the most common presenting complaints in any neurology outpatient department. International Headache Society classifies headaches as "primary" or "secondary". The causes of secondary headaches are varied and intracranial hypotension is one of them. It typically presents clinically with postural headaches but most of the times, its diagnosis is delayed, as it is an uncommon cause and there is poor awareness among the medical fraternity about this condition. Imaging, especially magnetic resonance imaging (MRI), plays a crucial role in the diagnosis of intracranial hypotension by not only confirming the diagnosis but also detecting the cause in some cases. This case series tries to highlight the MRI findings of intracranial hypotension in three cases with different etiologies.

Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment

“…Other accompanying features involve vertigo, tinnitus, visual disturbances such as blurred vision or bitemporal hemianopia, dysgeusia, hearing loss, gait ataxia, radicular arm pain, and cranial nerve deficits, such as diplopia, most frequently due to VI palsy, facial weakness, or numbness [1,2,7,11,[23][24][25]. Although much rarer, cognitive decline [26], parkinsonism [27], chorea [28], quadriplegia [29], seizures [2], Meniere-like syndrome [30], hyperprolactinemia, and galactorrhea [3], as well as positional loss of consciousness and coma due to diencephalic herniation [31], have been also reported. In rare cases, focal back pain may reveal the site of CSF leakage [11].…”

“…Headache can be focal or generalized, bilaterally located in the occipital region [3,11], and may be throbbing or more commonly non-throbbing [3,7,15]. Headache often worsens with Valsava maneuver, jugular vein compression, head movement, or coughing [29,32]. Its severity is highly variable, and mild cases may remain undiagnosed [11].…”