# Diagnosis and Management of Spontaneous Intracranial Hypotension Due to a CSF Leak: A Case of Spontaneous Recovery

## TL;DR

A 55-year-old man with spontaneous intracranial hypotension due to a CSF leak experienced spontaneous recovery without intervention.

## Contribution

This case highlights the possibility of spontaneous recovery in spontaneous intracranial hypotension.

## Key findings

- The patient showed improvement in symptoms without undergoing a planned epidural blood patch.
- A CT myelogram identified a CSF leak at the T1/T2 level caused by a bony spur.
- Serial follow-ups were advised instead of immediate intervention due to symptom improvement.

## Abstract

Spontaneous intracranial hypotension (SIH) is a rare condition typically caused by a CSF leak at the level of the spine, leading to a reduction in intracranial pressure (ICP). This case describes a 55-year-old man who presented with visual disturbance, intermittent occipital headaches, nausea, altered hearing, and unsteady gait. The initial MRI of the head showed shallow bilateral subdural hematomas, which were believed to be secondary to the stretching of subdural veins. A diagnosis of probable intracranial hypotension was made and further radiological imaging of the spine was carried out to look for the presence of a CSF leak. A CT myelogram identified a CSF leak in the anterior part of the dura at the T1/T2 level, which was believed to be secondary to a bony spur. There are no well-defined statistics on the incidence of the causes of SIH. After a multidisciplinary discussion, a targeted CT-guided epidural blood patch was planned; however, the patient reported improvement in symptoms, so the procedure was abandoned, with serial follow-ups advised.