Orthostatic headache from spontaneous spinal cerebrospinal fluid leakage; diagnosed by heavily T2-weighted magnetic resonance myelography.

Orthostatic headache is derived from low cerebrospinal fluid (CSF) pressure as evidenced by cranial magnetic resonance myelography (MRM). This reports three cases of patients coming with orthostatic headache without previous obvious spine trauma. The first two cases had headache with radiating neck pain while the third case had headache with radiating pain to the eye sockets or occasional nausea. The third case was diagnosed from cranial MR imaging. The three cases were not done for CSF opening pressure measuring or criterion's method myelography, but had done T2-weighted MR. All of three cases had spinal epidural collections. The second case had meningeal diverticula. The present report found a possible site of leak in all cases. In the present report, T2-weighted MR myelography could avoid dural puncture. It was used as a non-radiation exposure investigating technique. This technique can be used as the first line of investigation prior to CTM, guiding a radiologist to seek the most likely site of leak during CTM study.