spontaneous intracranial hypotension

- insidious CSF leak leads to low CSF pressure
- presents with orthostatic headache associated with nausea and vomiting, horizontal diplopia, unsteadiness or vertigo, altered hearing, neck pain/stiffness, interscapular pain
- diagnosis confirmed by measuring CSF opening pressure on LP : below 60mm water
- MRI: diffuse pachymeningeal enhancement with 'sagging' of brain, tonsilar descent, and posterior fossa crowding
- management: bed rest, increase fluid intake, analgesia, epidural blood patch