![]() ![]() We report a case of SIH, with all three complications described above. Failure to diagnose may lead to life threatening complications including SAH, SDH, and CVT. ![]() Careful history taking is the key in making the diagnosis. Headaches are typically orthostatic but can also present as persistent daily headaches. SIH usually presents with headaches following a dural sleeve tear resulting in CSF leak. Spontaneous intracranial hypotension (SIH) is often an underdiagnosed condition resulting from low cerebral spinal fluid (CSF) pressure. We strongly emphasize that appropriate history taking is the key in the diagnosis of SIH and providing timely treatment with an epidural blood patch could prevent potentially life threatening complications. Revisiting the history and significant improvement in symptoms following an epidural blood patch resulted in the diagnosis of SIH. The key aspect in the history “postural headaches” was missed, and this led to life threatening complications and unnecessary interventions. We present a patient with spontaneous intracranial hypotension (SIH) who had an incidental ophthalmic artery aneurysm on MR imaging, and this presentation led to coiling of the aneurysm. Given the combination of these imaging findings and a severe headache, the patients are often confused to have a primary subarachnoid hemorrhage. Furthermore, imaging of the brain vasculature may reveal incidental asymptomatic small aneurysms. It is rare to see all the complications in one patient. Undiagnosed intracranial hypotension can result in several complications including subdural hematoma (SDH), subarachnoid hemorrhage (SAH), dural venous sinuses thrombosis (CVT), cranial nerve palsies, and stupor resulting from sagging of the brain. ![]()
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December 2022
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