American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2015, 3(10), 314-318
DOI: 10.12691/ajmcr-3-10-3
Open AccessCase Report

Spontaneous Intracranial Hypotension Following a Yoga Class: A Case Report

Blumer V1, Rosemberg D2, Kaswan E3 and Lustgarten L4,

1Internal Medicine, Jackson Memorial Hospital, Miami, USA

2Physical Therapy and Rehabilitation, Centro Clinico Profesional Caracas, Caracas, Venezuela

3Internal Medicine, Hospital de Clinicas Caracas, Caracas, Venezuela

4Neurosurgery, Hospital de Clinicas Caracas, Caracas, Venezuela

Pub. Date: August 31, 2015

Cite this paper:
Blumer V, Rosemberg D, Kaswan E and Lustgarten L. Spontaneous Intracranial Hypotension Following a Yoga Class: A Case Report. American Journal of Medical Case Reports. 2015; 3(10):314-318. doi: 10.12691/ajmcr-3-10-3

Abstract

Spontaneous intracranial hypotension (SIH) is an underdiagnosed syndrome and initially missed cause of headaches. The classical presentation is that of an orthostatic headache, mainly caused by spontaneous and difficult to detect spinal CSF leaks. The current case report describes a 38 year old female patient who presented with symptoms following a Yoga class. Despite being initially misdiagnosed, her clinical course and radiological findings made it clear that she had intracranial hypotension syndrome with bilateral chronic subdural hematomas and cerebellar descent. She responded to surgical drainage of both her subdural hematomas and conservative management for her suspected CSF leak. This case, to our knowledge, is the first report in the literature of spontaneous intracranial hypotension being caused by a Yoga class. The report highlights the fact that some cases of SIH can be difficult to diagnose as their symptoms may be very confusing. Thorough interrogation of patients is vital, as trivial efforts and some exercising activities could be the cause of spontaneous dural tears. Early recognition is important to prevent unnecessary investigations and procedures, and to minimize delay in treatment.

Keywords:
spontaneous intracranial hypotension orthostatic headache low pressure headache CSF leak Yoga

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References:

[1]  Schievink, W. Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension. JAMA. 2006;295:2286-229.
 
[2]  Frank L, Paxson A, Brake J. Spontaneous Intracranial Hypotension - A Case Report. J Emerg Med. 2005; 28(4): 427-430.
 
[3]  Schievink W, Deline C. Headache Secondary to Intracranial Hypotension. Curr Pain Headache Rep. 2014; 18:457.
 
[4]  Mokri B. Spontaneous CSF Leaks - Low CSF Volume Syndromes. Neurol Clin. 2014; 32: 397-422
 
[5]  Davis J, Yanny I, Chatu S, et al. Spontaneous cerebrospinal fluid leak following a pilates class: a case report. J Med Case Rep. 2014; 8: 456.
 
[6]  Spears, R. Low-Pressure/Spinal Fluid Leak Headache. Curr Pain Headache Rep. 2014; 18:425.
 
[7]  Lahoria R, Allport L, Glenn D, et al. Spontaneous low pressure headache – A review and illustrative patient. J Clin Neurosci. 2012; 19: 1076-1079.
 
[8]  Tuchin P. A systematic literature review of intracranial hypotension following chiropractic. Int J Clin Pract. 2014; 68(3): 396-402.
 
[9]  International Headache Society Classification Subcommittee. International classification of headache disorders, 3rd edition. Cephalalgia. 2013; 33(9): 629-808.
 
[10]  Scott S, Davenport R. Low pressure headaches caused by spontaneous intracranial hypotension. BMJ. 2014; 349:6219.
 
[11]  Malone R, Love J. Spontaneous Intracranial Hypotension: Case Report and Relevant Review of the Literature. J Emerg Med. 2007; 32 (4): 371-374.
 
[12]  Yoon S, Chung Y, Yoon B, et al. Clinical experiences with spontaneous intracranial hypotension: A proposal of a diagnostic approach and treatment. Clin Neurol Neurosurg. 2011; 113: 373-379.
 
[13]  Chen H, Huang C, Hseu S, et al. Bilateral Subdural Hematomas Caused by Spontaneous Intracranial Hypotension. J Chin Med Assoc 2008;71(3):147-151
 
[14]  Kim B, Jung Y, Kim M, et al. Chronic Subdural Hematoma after Spontaneous Intracranial Hypotension: A Case Treated with Epidural Blood Patch on C1-2. J Korean Neurosurg Soc. 2001; 50: 274-276.
 
[15]  Watanabe A, Horikoshi T, Uchida M, et al. Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome. Am J Neuroradiol. 2009;30:147-51.
 
[16]  Schievink WI. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia. 2008; 28: 1345-56.
 
[17]  Schievink WI, Meyer FB, Atkinson JLD, et al: Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg. 1996; 84: 598-605.
 
[18]  Schievink WI, Morreale VM, Atkinson JLD, et al: Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg. 1998; 88: 243-246.
 
[19]  Bousser MG. Headache in spontaneous cerebrospinal fluid hypotension. Rev Neurol (Paris). 2005; 161(6-7):700-2.
 
[20]  Mokri B. Spontaneous Low Pressure, Low CSF Volume Headaches: Spontaneous CSF Leaks. Headache. 2013; 53 (7):1034-1053.
 
[21]  Warnick W, Neal J. Beyond Spinal Headache: Prophylaxis and Treatment of Low-Pressure Headache Syndromes. Reg Anesth Pain Med. 2007;32:455-461.
 
[22]  Kantor D, Silberstein S. Cervical epidural blood patch for low CSF pressure headaches. Neurology. 2005; 65(1): 1138.
 
[23]  Madsen SA, Fomsgaard JS, Jensen R. Epidural blood patch for refractory low CSF pressure headache: a pilot study. Headache Pain. 2011; 12:453-457.
 
[24]  Shrikrishna D, Green C, Wood D, et al. Life-threatening spontaneous intracranial hypotension responding to epidural blood patch. BJA. 2006; 97(5): 750.
 
[25]  Ferraro F, Marano E, Petruzzi J, et al. Spontaneous intracranial hypotension and epidural blood patch: a report involving seven cases. Anaesth Intensive Care. 2013; 41(3): 393-6.
 
[26]  Beleña JM, Nuñez M, Yuste J, et al. Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch. Acta Anaesthesiol Scand. 2012; 56(10):1332-5.
 
[27]  Ohtonari T, Ota S, Nishihara N, et al. A novel technique of multiple-site epidural blood patch administration for the treatment of cerebrospinal fluid hypovolemia. J Neurosurg. 2012; 116(5):1049-53.
 
[28]  Franzini A, Messina G, Nazzi V, et al. Spontaneous intracranial hypotension syndrome: a novel speculative physiopathological hypothesis and a novel patch method in a series of 28 consecutive patients. J Neurosurg. 2010;112(2):300-6.