A complicated case of intracranial hypotension: diagnostic and management strategies

Abstract

We report a case of a patient aged 66 years, with spontaneous intracranial hypotension presenting initially with postural headache, complicated by subdural haematomas and followed by progressive decline of his clinical condition evolving in obtundation state, cranial nerve involvement and gaze paralysis. The patient underwent a long course of different therapeutical approaches: medical and surgical treatment, intrathecal saline infusion and epidural blood patching (EBP). Rapid and dramatic relief of the patient’s symptoms was obtained after a third lumbar EBP and he was discharged asymptomatic two weeks later.