Spontaneous intracranial hypotension syndrome presented with sixth cranial nerve palsy: a case report

Introduction Spontaneous intracranial hypotension (SIH) is a secondary cause of headache often misdiagnosed and underdiagnosed disorder. The main presentation orthostatic headache. An uncommon symptom cranial nerve palsy. We described case SIH that presented to our service with sixth Case Report Female, 39 years old, no relevant medical past or history trauma, awoke due intense holocranial headache, associated vomiting photophobia, worsening in orthostasis. In the general emergency department, she was release prescription analgesics topiramate, without resolution. After week, patient reported diplopia referred service, tertiary center. admission, kept an neurologic examination right palsy, other deficits. Laboratorial tests were normal, including metabolic infectious marks. Cerebrospinal fluid (CSF) opening pressure low (50 mmH2O) analysis showed elevated protein levels (158mg/dl). MRI diffuse pachymeningeal enhancement venous sinus distension, mainly superior sagittal sinus. CT myelogram detected spinal CSF leak transition C1-C2. Initially, performed hydration bed rest, while partial improvement epidural blood patch then using 15ml autologous compatible contrast lidocaine. There complete resolution pain after procedure four weeks later Discussion According International Classification Headaches Disorders, third edition (ICHD-3), attributed descripted as has developed temporal relation (<60mm H2O) and/or evidence leakage on imaging. (To see abstract, please, check out PDF).