A case of spontaneous intracranial hypotension with a remarkable leakage and collection of CSF

We reported a case of spontaneous intracranial hypotension (SIH) who exhibited a remarkable leakage and collection of CSF in the spinal vertebral column. A 28-year old woman suddenly developed a severe occipital headache and vomiting. She had no headache while lying, but the headache was severe while sitting and standing. She had no recent history of trauma, but she fell down and hit her neck while skiing 6 months before the onset of headache. Neurological examination, urine and blood tests failed to reveal abnormal findings. Lumbar puncture showed a very low CSF pressure of 10 mmHg. Brain MRI demonstrated diffuse thickening and contrast enhancement of the meninges and spinal MRI displayed a CSF collection in the epidural spaces. RI cisternography showed a CSF leakage and an early accumulation of isotope in the kidneys and urinary bladder. Myelography revealed a CSF leakage at the C 2 level from the spinal sac out to the extravertebral tissue and a CSF collection in the epidural spaces in the cervical to lumbar spinal canal. The root sleeves were also visualized by the CSF leakage. Thus, we demonstrated in this patient with SIN the location of CSF leakage at C2 dural sac and an extensive collection of leaked CSF in the epidural spaces, which apparently played a role in the occurrence of SIN.