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A 39-year-old woman presented with a 4-
week history of progressive postural headache
accompanied by dizziness and vomiting.
By lying down all symptoms relieved.The patient
was afebrile with no apparent meningeal
signs and any trauma. No focal neurological
signs were noted. Cerebral and spinal MR
imaging revealed a diffuse pachymeningeal
contrast enhancement. Spontaneous intracranial
hypotension was suspected on the basis
of clinical and neuroradiological findings
confirmed by a low CSF pressure at lumbar
puncture. Other causes of leptomeningeal
diseases were excluded. Conservative treatment
including bed rest, intravenous volume
administration and intravenous coffeine as
well as oral administration of prednisone was
continued over one week with short lasting
success. However, 3 weeks later headaches
relapsed. A CT-myelography now revealed a
CSF leakage at the cervical level C1-2 as well
as at C6-7. After an epidural blood patch
at the level C1 and C2 postural headaches
disappeared after several days. Months later
the patient was still in remission of her
symptoms and follow-up MRI scans showed
a persisting epidural CSF accumulation at
C1-2 and cervico-thoracal but no more dural
enhancement.These clinical and radiological
findings are most likely the result of in the
meantime occurred balance between CSF
loss and production.This case seems to be the
first one describing two independent, spontaneous
cervical CSF leakages causing an
intracranial hypotension syndrome.