Spontaneous intracranial hypotension: A rare cause of chronic headache

Spontaneous intracranial hypotension is a rare cause of chronic postural he adache. We report the case of a 58-year-old woman with a 1.5 year history o f chronic headache in upright position, nausea and vomiting. Neurological e xamination was normal. The Gd-enhanced MRI of the brain showed an abnormal meningeal enhancement over the cerebral convexity. The CSF was normal. Open ing pressure during lumbar puncture was 6 cm H2O in the lateral recumbent p osition. No evidence of underlying systemic, infectious or neoplastic disea ses could be detected. The headache was alleviated under theophylline thera py. Spontaneous intracranial hypotension should be considered in the differ ential diagnosis of chronic postural headache. MRI revealing meningeal enha ncement and low opening pressure in lumbar puncture are important findings for the diagnosis of spontaneous intracranial hypotension.