Spontaneous intracranial hypotension and bilateral subdural hematoma in the spectrum of antiphospholipid syndrome and systemic lupus erythematosus: a challenging clinical encounter

Spontaneous intracranial hypotension (SIH) linked to the leakage of cerebrospinal fluid typically manifests as positional headaches. The connection between connective tissue disorders and SIH is widely recognized. Nevertheless, instances of SIH related to systemic lupus erythematosus are infrequently reported. We report a 42-year-old female with systemic lupus erythematosus and antiphospholipid syndrome who presented with severe orthostatic headaches. Imaging revealed bilateral subdural hematomas and diffuse pachymeningeal enhancement. Conservative treatment was administered, and the patient showed improvement with resolution of symptoms. It is important to note that not all imaging studies consistently reveal all the characteristic features of SIH. Due to these diagnostic limitations, it is crucial for clinicians to consider a combination of patient history, clinical evaluation and imaging findings meticulously.