Spontaneous Intracranial Hypotension – Not Always Benign

Background and Aim: Spontaneous Intracranial Hypotension (SIH) is a rare cause of headaches. It commonly presents with newly-developed persistent postural headaches and resolves with conservative treatment but rarely becomes a life-threatening disease. We retrospectively reviewed all cases of SIH patients treated in our institution for over ten years. Their clinical and radiological findings and the treatment given were analyzed. Their outcomes were assessed at a minimum of one year of follow-up. Materials and Methods: We retrospectively reviewed all cases of SIH patients treated in our institution over ten years. Clinicoradiological aspects, as well as the treatment given, were analyzed. The outcome was assessed at a minimum of one year of follow-up. Results: Six cases of SIH were studied. The Mean±SD age of the study population was 41.6±2.87 years. Four cases (66%) were female. The most common symptom was orthostatic headache which was present in all of them. The Mean±SD duration of symptoms before the diagnosis of SIH was 3±1.78 months. Four cases were managed conservatively, while one patient was managed with surgery and the other with epidural patch repair. The exact site of the leak could be delineated in 2 cases (33%). Two patients who were managed invasively for Cerebrospinal Fluid (CSF) the leak had a subdural hematoma. All patients had a favorable outcome at one year of follow-up. Conclusion: Prompt and early identification of changes in symptom pattern and the onset of subdural hematoma are essential markers of shifting to definitive management rather than continuing conservative measures. Subdural hematoma, secondary to SIH, warrants evacuation if it causes clinical deterioration.