Spontaneous Intracranial Hypotension in a Postpartum Woman: A Case Report

Abstract

Spontaneous intracranial hypotension (SIH) is a clinical syndrome caused by spontaneous cerebrospinal fluid (CSF) leakage, most commonly due to a defect in the spinal dura mater, occurring in the absence of preceding trauma, invasive procedures, or lumbar puncture. The hallmark manifestation is orthostatic headache, characterized by worsening in the upright position and relief upon recumbency. We report the case of a 31-year-old woman who developed symptoms three months after an induced vaginal delivery at 40 weeks of gestation. She presented with a progressively worsening headache exhibiting marked postural dependence, becoming severe upon standing and partially relieved in the supine position. The pain was refractory to oral and intravenous analgesics and was accompanied by photophobia, phonophobia, nausea, repeated vomiting, and neck stiffness, while neurological examination revealed no focal deficits. Initial cranial computed tomography was unremarkable. Brain magnetic resonance imaging (MRI), including MR angiography and MR venography, demonstrated diffuse pachymeningeal thickening, small subdural effusions in the occipital and infratentorial regions, and mild venous sinus engorgement. Cervical spine MRI revealed anterior dural effusion extending from C1 to C7, supporting the diagnosis of spinal CSF hypovolemia. The patient was treated conservatively with bed rest, hydration, and caffeine, resulting in gradual clinical improvement without the need for epidural blood patching. This case highlights the importance of recognizing orthostatic headache as a key diagnostic clue, particularly in the postpartum period. Early MRI evaluation is essential, as timely identification of SIH enables appropriate management and may prevent potentially serious complications.