Spontaneous intracranial hypotension:: Case report with subdural hematomas, steroid dependency and clinical improvement after myelography

Objective: In spontaneous intracranial hypotension (SIH), also known as spontaneous hypoliquorrhea, an abnormally low intracranial pressure leads to posture-dependent headaches similar to those observed after lumbar puncture. Although its etiology is not yet fully understood, it is now diagnosed more often as clinical awareness increases and the availability of MRI becomes more widespread. Clinical presentation: We report the case of a 42-year-old patient with SIH who developed bilateral subdural hematomas (SDH) and symptomatic diencephalic herniation requiring surgical evacuation. Remarkably, he also developed partial pituitary insufficiency. Therapy: After SDH was evacuated twice without success, his symptoms resolved rapidly after a diagnostic myelography. Conclusion: Besides the orthostatic headache, the possible clinical manifestations are numerous. Serious complications and situations may occur that need to be recognized and treated. In addition to presentation of the case the literature to date is reviewed and discussed.