Teaching NeuroImages: CSF leaks and spontaneous intracranial hypotension

Abstract

A 30-year-old man developed a severe postural headache over a period of a month. MRI revealed diffuse dural enhancement (figure 1), and radionuclide cisternography showed widespread CSF leaks (figure 2). It has been suggested that spontaneous intracranial hypotension is caused by CSF leakage, but he has no clinical manifestation associated with connective tissue disease, or other medical condition to cause CSF leakages.1,2 To work effectively, he has repeatedly jumped around in a quarry. Therefore, we could suggest that the etiology was the cumulative effects of stressful impact to his spine.