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Neurological Sciences

, Volume 40, Issue 10, pp 2179–2181 | Cite as

Widening the spectrum of secondary headache: intracranial hypotension following a non-aneurysmal subarachnoid hemorrhage

  • Valentina OppoEmail author
  • Giovanni Cossu
  • Simona Secci
  • Maurizio Melis
Letter to the Editor
  • 37 Downloads

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.

Keywords

Subarachnoid hemorrhage Perimesencephalic Intracranial hypotension Spinal epidural hematoma 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Mokri B (2014) Spontaneous CSF leaks: low CSF volume syndromes. Neurol Clin 32(2):397–422CrossRefGoogle Scholar
  2. 2.
    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):673–679CrossRefGoogle Scholar
  3. 3.
    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):433–440CrossRefGoogle Scholar
  4. 4.
    Webb AJS, Flossmann E, Armstromg RJ (2015) Superficial siderosis following spontaneous intracranial hypotension. Pract Neurol 15(5):382–384CrossRefGoogle Scholar
  5. 5.
    Schievink WI, Maya MM (2016) Diffuse non-aneurysmal SAH in spontaneous intracranial hypotension: sequela of ventral CSF leak? Cephalalgia 36(6):589–592CrossRefGoogle Scholar
  6. 6.
    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):1063–1065CrossRefGoogle Scholar
  7. 7.
    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):267–271CrossRefGoogle Scholar
  8. 8.
    Schievink WI (1997) Intracranial aneurysms. N Engl J Med 336(1):28–40CrossRefGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Neurology Service and Stroke Unit, Department of NeuroscienceAO BrotzuCagliariItaly
  2. 2.Radiology DepartmentAO BrotzuCagliariItaly

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