Spontaneous Intracranial Hypotension Presenting With Acute Orthostatic Headache: A Case Report
- 1Acute Medicine, Manchester Royal Infirmary, Manchester, GBR
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.
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BibTeX
@article{arose2026spontaneous,
title = {{Spontaneous Intracranial Hypotension Presenting With Acute Orthostatic Headache: A Case Report}},
author = {Ali Ben Arose and Geetanjali Gupta and Fatima Saeed},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117240},
url = {https://europepmc.org/article/PMC/PMC13722357},
note = {CC BY},
}
RIS
TY - JOUR
TI - Spontaneous Intracranial Hypotension Presenting With Acute Orthostatic Headache: A Case Report
AU - Ali Ben Arose
AU - Geetanjali Gupta
AU - Fatima Saeed
PY - 2026
DA - 2026/09/30
JO - Cureus
DO - 10.7759/cureus.117240
UR - https://europepmc.org/article/PMC/PMC13722357
AB - 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.
SN - 2168-8184
ER -