Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
A 33-year-old man presented in 2002 with an acute, severe, occipital headache associated with nausea and photophobia, causing him to collapse to the pavement; there was no persisting neurological impairment. He had mild hypertension, hypercholesterolaemia and asthma, but took no regular medication. His initial neurological examination was normal. A CT scan of head was normal but cerebrospinal fluid (CSF) showed xanthochromia, but was otherwise normal. A four-vessel digital subtraction cerebral angiogram was normal. He took nimodipine for 3 weeks and was discharged.
He subsequently developed recurrent left-sided headaches, each lasting hours to days, with backache and dizziness, nausea and photophobia. These varied in frequency and severity but progressed over time, eventually having more days with headache than without. Following a more severe episode, he required hospital admission, with a diagnosis of migraine. In 2008, he developed neck pain with tingling in his left middle finger. An MR scan of cervical spine showed a posterior osteophytic bar with root impingement at C5/6 and C6/7. He obtained temporary relief from a nerve root blockade at both levels but eventually underwent a C5/6/7 anterior cervical decompression and fusion.
In 2014, he became progressively unsteady and developed a subtle right-hand tremor. One day he woke with severe headache with nausea, vomiting and photophobia, with worsened unsteadiness. On examination there was mild ataxia on tandem gait with scanning dysarthria. CT scan of …
Contributors AJSW cared for the patient and drafted the manuscript. RJEA and EF cared for the patient, supervised the case report and edited the manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Julian Fearnley, London, UK.
Read the full text or download the PDF:
Other content recommended for you
- Classical infratentorial superficial siderosis of the central nervous system: pathophysiology, clinical features and management
- Severe acute orthostatic headache: spontaneous intracranial hypotension (SIH)
- Recurrent spontaneous intracranial hypotension in early pregnancy
- Orthostatic hearing loss: audiovestibular manifestations of spontaneous intracranial hypotension
- Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension
- Complicated spontaneous intracranial hypotension treated with intrathecal saline infusion
- Spontaneous intracranial hypotension presenting with progressive cognitive decline
- Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension
- Spontaneous intracranial hypotension and venous sinus thrombosis
- Management of spontaneous intracranial hypotension – Transorbital ultrasound as discriminator