Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid leaks.

A 37-year-old woman presented with acute orthostatic hypotension and diffuse headache. Brain magnetic resonance imaging (MRI) revealed T2 hyperintense bilateral subdural effusions, diffuse pachymeningeal enhancement, slit ventricles and venous engorgement compatible with spontaneous intracranial hypotension. Single photon emission computed tomography with computed tomography (CT) and CT-cisternography showed a cerebrospinal fluid (CSF) leak at the left C1-C2 transition. Spontaneous intracranial hypotension is a rare cause of daily headache, which remains largely underdiagnosed1,2, and current evidence indicates that this condition is the result of a spontaneous CSF leak1,2,3,4. This case illustrates the importance of CT-cisternography in the detection of CFS leak1,2,3, allowing appropriate diagnosis and treatment.