Spontaneous intracranial hypotension (SIH) is a rare cause of persistent headache, particularly among young and middle-aged people. A potentially life-threatening complication SIH cerebral venous thrombosis (CVT). The authors present case in which patient presented with complicated by CVT one week after receiving booster dose mRNA COVID-19 vaccine. According to our literature review, this the f...

This case expands our knowledge of the spectrum of manifestations of spontaneous intracranial hypotension. A 42-year-old man was seen for a third neurolog-ical opinion for obtundation. He presented with a 1-month history of new-onset, daily, intense, right-sided headaches (information about postural precipitation is not available). A magnetic resonance imaging (MRI) scan of the brain showed dif...

A literature search found no clinical trials or guidelines addressing the management of spontaneous intracranial hypotension (SIH). Based on the available literature and expert opinion, we have developed recommendations for the diagnosis and management of SIH. For typical cases, we recommend brain magnetic resonance (MR) imaging with gadolinium to confirm the diagnosis, and conservative measure...

We report three patients with spontaneous intracranial hypotension in whom spinal MR imaging revealed ventral extradural fluid collections that were centered at the cervicothoracic junction in two patients and extended throughout the entire spine in the third patient. These spinal fluid collections most likely resulted from the accumulation of CSF at the site of dural leakage. Knowledge of this...

A 44-year-old woman presented with sudden onset of occipital headache and neck stiffness for 3 weeks. The headache was pulling in character and worse in the morning (visual analogue scale pain score of 8). Coughing, straining when passing a stool, and postural change (either going from a lying to an erect position or vice versa) provoked the headache. It was associated with vertigo, nausea, and...

To the Editor:—The case reported by Dietrich and Smith again demonstrates that performing steroid epidural injections under fluoroscopic guidance does not absolutely prevent perforation of the dura by the needle tip, because the needle is usually advanced before the next bolus of dye is injected. Measurements of skin to epidural space in magnetic resonance imaging films showed that the posterio...

To the Editor:—The case reported by Dietrich and Smith again demonstrates that performing steroid epidural injections under fluoroscopic guidance does not absolutely prevent perforation of the dura by the needle tip, because the needle is usually advanced before the next bolus of dye is injected. Measurements of skin to epidural space in magnetic resonance imaging films showed that the posterio...

Cerebrospinal fluid (CSF) leakage is known to cause orthostatic headache. Spontaneous CSF leakage occurs under several conditions, such as lumbar puncture, spinal surgery, and fracture of the spine. Intrasacral meningocele is an anomaly caused by an abnormal prolongation of the meninges in the sacral spinal canal. Typical symptoms of this anomaly are low back pain, bladder dysfunction, and scia...

Spontaneous intracranial hypotension (SIH) is caused by leakage of CSF, and characterized on MRI by brain sagging, dilatation of veins and dural sinuses, subdural fluid collections and post-contrast enhancement of the thickened dura. A few cases may present a very severe brain sagging through the tentorial notch and swelling of the diencephalic-mesencephalic structures, with absent or scarce su...

BACKGROUND Various types of lumbar dural punctures may contribute to neurological injury. The etiologies of dural injury include; inadvertent dural punctures due to epidurals placed for labor anesthesia, epidural steroid injections (ESI/transforaminal TESI; approximately 9 million ESI performed in the US per year), deliberate placement of intradural pain devices, and spontaneous cerebrospinal f...