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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2025; 14(02): 165-168
DOI: 10.1055/s-0043-1761428
Case Report

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

M.K. Saranraj
1   Department of Neurosurgery, Apollo Hospitals, Teynampet, Chennai, Tamil Nadu, India
,
K. Giridharan
1   Department of Neurosurgery, Apollo Hospitals, Teynampet, Chennai, Tamil Nadu, India
,
Sudhakshina Nathan 
1   Department of Neurosurgery, Apollo Hospitals, Teynampet, Chennai, Tamil Nadu, India
,
Nadasha M. Babu
1   Department of Neurosurgery, Apollo Hospitals, Teynampet, Chennai, Tamil Nadu, India
,
Mangaleswaran Balamurugan
1   Department of Neurosurgery, Apollo Hospitals, Teynampet, Chennai, Tamil Nadu, India
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Abstract

Introduction

Spontaneous intracranial hypotension (SIH) is a misdiagnosed condition characterized by low cerebrospinal fluid (CSF) volume and an orthostatic headache that worsens with upright posture due to CSF leak at spinal dural defects. SIH due to CSF leak at multiple spinal levels is a rare condition, and only a few cases have been reported in the literature. Here, we report a case of SIH with a CSF leak at multiple spinal levels. The treatment options and efficacy of epidural blood patch (EBP) injection were discussed in this article.

Case Report

A 36-year-old man presented with complaints of orthostatic headache for 2 months and a computed tomography myelogram demonstrated CSF leaks at multiple spinal levels through the dural defects at C5-C6, C6-C7, C7-T1, T1-T2 levels, and at L1, L2, L3, and L4 vertebral levels on the left side. He was managed with a targeted EBP injection and he improved symptomatically within 24 hours of the EBP injection.

Summary

SIH is an entity that results from CSF leakage, often through spinal dural defects due to mechanical tear by osteophyte complex, disc prolapse, connective tissue disorders, CSF-venous fistula, and leaking meningeal diverticula. SIH can result from single or multiple dural leaks, but spinal leaks at multiple levels are uncommon. To the best of our knowledge, a total number of 163 cases have been reported in the literature so far. With good success rates, targeted EBP injection with autologous blood is an effective treatment option for both single-level and multiple-level spinal leaks.

Keywords

spontaneous intracranial hypotension - multiple spinal CSF leaks - epidural blood patch injection


Publication History

Article published online:
23 February 2023

© 2023. Neurological Surgeons' Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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