# A case of conservatively managed idiopathic spinal cord herniation presenting with low-pressure headache

## TL;DR

A rare case of spinal cord herniation causing low-pressure headaches was successfully treated without surgery.

## Contribution

This is only the fourth reported case of spontaneous ventral cord herniation presenting with low-pressure headaches, supporting conservative management.

## Key findings

- A 35-year-old woman with thoracic ventral spinal cord herniation had low-pressure headaches and no focal neurological symptoms after 12 months.
- Spontaneous ventral cord herniation may result from an initial CSF leak through a dural defect.
- Conservative management is recommended for similar cases based on the proposed pathophysiology.

## Abstract

Idiopathic spinal cord herniation presenting with low-pressure headache is extremely rare. We present a case of thoracic ventral spinal cord herniation in a 35-year-old lady who presented with low-pressure headaches. To our knowledge, this is only the fourth case described in the literature of spontaneous ventral cord herniation presenting in this way. The patient was managed conservatively with no manifestation of focal neurological symptoms at 12-month follow-up. The proposed aetiology of spontaneous ventral cord herniation is an initial CSF leak via a dural defect, through which the cord subsequently also enters blocking the CSF leak. We endorse a conservative approach for patients who present similarly, secondary to the above pathophysiology.