Spontaneous intracranial hypotension with magnetic resonance localisation of spinal cerebrospinal fluid leak

To increase the awareness of spontaneous intracranial hypotension [SIH], we report in this paper a middle-aged woman who presented with an intractable headache that worsened in sitting and standing positions [a postural headache]. Magnetic resonance imaging [MRI] of the spine demonstrated a cerebrospinal fluid [CSF] leak at the level of the cervical spine, in addition to typical features in a brain MRI, including symmetrical subdural collections, circumferential dural enhancement and features of midbrain sagging. The patient underwent a surgical repair of the cervical CSF leak which resulted in a dramatic symptomatic improvement that was confirmed by follow-up imaging