Spontaneous Intracranial Hypotension Presenting With Acute Orthostatic Headache: A Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Spontaneous intracranial hypotension (SIH) is an uncommon and frequently under-recognized cause of orthostatic headache, resulting from spontaneous cerebrospinal fluid (CSF) leakage. We report the case of a 39-year-old woman who presented to the Manchester Royal Infirmary hospital with sudden-onset neck pain and headache associated with dizziness, vomiting, and presyncope, markedly worse on standing and relieved by lying flat. The patient's neurological examination was normal; however, she was hypotensive and unable to tolerate an upright posture. Initial computed tomography (CT) and CT angiography of the head were unremarkable. In addition, magnetic resonance imaging (MRI) of the brain and spine with contrast demonstrated diffuse pachymeningeal enhancement and an extensive spinal longitudinal epidural CSF collection extending from the cervical to lumbar spine, consistent with SIH secondary to a spinal CSF leak. She required admission and neurosurgical referral for further investigation and management. This case highlights the importance of recognizing SIH in patients presenting with acute orthostatic headache and neck pain, even in the absence of trauma or focal neurological deficit.
Source: Cureus
Authors: Ali Ben Arose, Geetanjali Gupta, Fatima Saeed
Institution: Manchester Royal Infirmary
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214929197