1.Spontaneous Low Cerebrospinal Fluid Pressure Headache Initially Misdiagnosed as a Tension-type Headache
Hisashi Nishisako ; Hiroyuki Kunishima ; Gohji Shimizu ; Yoshiyuki Naitou ; Yoko Teruya ; Masatoshi Yokokawa ; Kentaro Masui ; Masanori Hirose ; Tsubasa Sakai ; Yukitaka Yamasaki ; Tomoya Tsuchida ; Takaaki Nemoto ; Keito Torikai ; Teisuke Nakagawa ; Takahide Matsuda
General Medicine 2014;15(1):43-46
We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.
Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.
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