Abstract
Background
Intracranial hypotension has been associated with a wide spectrum of neurological conditions including chronic non-aneurysmal and acute aneurysmal subarachnoid hemorrhage.
Case
A 59-year-old man presented with a non-aneurysmal subarachnoid hemorrhage in a perimesencephalic pattern after a mild physical exertion. In the course of the disease, a magnetic resonance imaging of head and spine displayed intracranial hypotension that resolved spontaneously.
Discussion
Long-standing intracranial hypotension has been reported as the cause of chronic subarachnoid hemorrhage and a single case of intracranial hypotension as the consequence of intracranial pressure fluctuations after acute aneurysmal subarachnoid hemorrhage has been described.
This is the first description of intracranial hypotension caused by acute non-aneurysmal subarachnoid hemorrhage. We hypothesize that blood in the subarachnoid space could have determined a spine cerebrospinal fluid leak through intracranial pressure fluctuations or mechanical action, causing arachnoiditis and possibly a dural tear.
References
Mokri B (2014) Spontaneous CSF leaks: low CSF volume syndromes. Neurol Clin 32(2):397–422
Schievink WI, Maya MM, Jean-Pierre S, Nuño M, Prasad RS, Moser FG (2016) A classification system of spontaneous spinal CSF leaks. Neurology 87(7):673–679
Schievink WI, Maya MM, Nuño M (2011) Chronic cerebellar hemorrhage in spontaneous intracranial hypotension: association with ventral spinal cerebrospinal fluid leaks. J Neurosurg Spine 15(4):433–440
Webb AJS, Flossmann E, Armstromg RJ (2015) Superficial siderosis following spontaneous intracranial hypotension. Pract Neurol 15(5):382–384
Schievink WI, Maya MM (2016) Diffuse non-aneurysmal SAH in spontaneous intracranial hypotension: sequela of ventral CSF leak? Cephalalgia 36(6):589–592
Sivakumar W, Ravindra VM, Cutler A, Couldwell T (2014) Intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage. J Clin Neurosci 21(6):1063–1065
Flaherty ML, Haverbusch M, Kissela B, Kleindorfer D, Schneider A, Sekar P, Moomaw CJ, Sauerbeck L, Broderick JP, Woo D (2005) Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome. J Stroke Cerebrovasc Dis 14(6):267–271
Schievink WI (1997) Intracranial aneurysms. N Engl J Med 336(1):28–40
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Oppo, V., Cossu, G., Secci, S. et al. Widening the spectrum of secondary headache: intracranial hypotension following a non-aneurysmal subarachnoid hemorrhage. Neurol Sci 40, 2179–2181 (2019). https://doi.org/10.1007/s10072-019-03809-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-019-03809-3