Intracranial Hypotension Presenting With Acute Severe Headache
Intracranial Hypotension Presenting With Acute Severe Headache
Introduction: Headache is a common presenting complaint and has a wide differential diagnosis. Clinicians need to be alert to clues that may suggest an underlying secondary aetiology. We describe a novel case of headache secondary to intracranial hypotension which was precipitated by the rupture of a spinal arachnoid cyst.
Case report: A 51-year-old Indian female presented with sudden onset severe headache suggestive of a subarachnoid haemorrage. Investigations including a computed tomography brain scan, cerebrospinal fluid examination and a magnetic resonance angiogram were normal. The headache persisted and magnetic resonance imaging revealed bilateral thin subdural collections, a spinal subarachnoid cyst and a right-sided pleural effusion. This was consistent with a diagnosis of headache secondary to intracranial hypotension resulting from spinal arachnoid cyst rupture.
Conclusions: Spinal arachnoid cyst rupture is a rare cause of spontaneous intracranial hypotension. Spontaneous intracranial hypotension is a common yet under-diagnosed heterogeneous condition. It should feature significantly in the differential diagnosis of patients with new-onset daily persistent headache.
Headache is a common presenting complaint. It is the most frequent neurological complaint seen in general practice, accounts for up to one-third of new outpatient neurology referrals, and is commonly seen in emergency departments. Most cases are due to so-called primary headache. However, clinicians need to be alert to clues, which may help to identify the minority with an underlying secondary cause. The differential diagnosis of acute severe headache covers a wide range of conditions, including subarachnoid haemorrhage, bacterial meningitis and migraine. We present a novel case of headache secondary to spontaneous intracranial hypotension, which was precipitated by the rupture of a spinal arachnoid cyst.
Abstract and Introduction
Abstract
Introduction: Headache is a common presenting complaint and has a wide differential diagnosis. Clinicians need to be alert to clues that may suggest an underlying secondary aetiology. We describe a novel case of headache secondary to intracranial hypotension which was precipitated by the rupture of a spinal arachnoid cyst.
Case report: A 51-year-old Indian female presented with sudden onset severe headache suggestive of a subarachnoid haemorrage. Investigations including a computed tomography brain scan, cerebrospinal fluid examination and a magnetic resonance angiogram were normal. The headache persisted and magnetic resonance imaging revealed bilateral thin subdural collections, a spinal subarachnoid cyst and a right-sided pleural effusion. This was consistent with a diagnosis of headache secondary to intracranial hypotension resulting from spinal arachnoid cyst rupture.
Conclusions: Spinal arachnoid cyst rupture is a rare cause of spontaneous intracranial hypotension. Spontaneous intracranial hypotension is a common yet under-diagnosed heterogeneous condition. It should feature significantly in the differential diagnosis of patients with new-onset daily persistent headache.
Introduction
Headache is a common presenting complaint. It is the most frequent neurological complaint seen in general practice, accounts for up to one-third of new outpatient neurology referrals, and is commonly seen in emergency departments. Most cases are due to so-called primary headache. However, clinicians need to be alert to clues, which may help to identify the minority with an underlying secondary cause. The differential diagnosis of acute severe headache covers a wide range of conditions, including subarachnoid haemorrhage, bacterial meningitis and migraine. We present a novel case of headache secondary to spontaneous intracranial hypotension, which was precipitated by the rupture of a spinal arachnoid cyst.