Spontaneous Intracranial Hypotension in Childhood: A Case Report and Review of the Literature

Abstract

Spontaneous intracranial hypotension results from 1 or more spontaneous spinal cerebrospinal fluid leaks, and generally presents with severe and persisting orthostatic headache. Diagnosis can be difficult as spontaneous intracranial hypotension is very rare in childhood and has a wide spectrum of clinical features and neuroimaging findings. Lumbar autologous epidural blood patch can be helpful for confirmation of diagnosis and symptom relief. We report a 15-year-old female with spontaneous intracranial hypotension who experienced immediate resolution of her symptoms following lumbar autologous epidural blood patch on 2 occasions, and review the literature on this well-recognized but probably underdiagnosed headache syndrome in childhood.

A Case of Spontaneous Intracranial Hypotension Accompanied by Acute Kidney Injury in a Child

“…Brain MRI has some characteristic ima- . However, about 20-30% of the patients can have normal findings on cranial MRI 3) . In our case, although brain MRI was not taken, brain CT showed [13][14][15][16][17] .…”

“…Most of the dural spontaneous tears often occur at the exit zone where the cervical and thoracic spinal roots leave the subarachnoid space 1,10,11) . Other leakage sites may include the cribriform plate or the pituitary fossa, and the leakage can occur from one or more sites 1,3,10) . The tear sites tend to have a larger diameter than those caused by iatrogenic needle injuries that can result in extensive CSF leakage involving several spine levels 9) .…”

“…The diagnosis can be confirmed by MRI or when CSF opening pressure is low (less than 60 mm H 2 O) in the presence of an orthostatic headache 1,3) . Brain MRI has some characteristic ima- .…”

“…Our patient's whole spine MRI showed an extensive retrospinal fluid collection throughout the entire thoracic and lumbar spine levels. Radioisotope cisternography and CT myelography can also be helpful in localizing the site of cerebrospinal fluid leak 3) .…”

“…The exact incidence of spontaneous intracranial hypotension in childhood has not been known. Spontaneous intracranial hypotension is characterized by a headache that develops on an upright position and is improved on lying down 3) . However, its clinical manifestations have a wide spectrum in children, and it can be difficult to diagnose.…”