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Background and Aims Spontaneous intracranial hypotension (SIH) is an increasingly recognized condition. While SIH was rarely diagnosed in the past, it is now acknowledged as an important cause of headaches. Spinal dural cerebrospinal fluid (CSF) leaks cause SIH, and in 20% of cases, they are associated with a meningeal diverticulum in the region of the nerve root.

Methods A 51-year-old, male patient, referred to neurology presenting with an 8-month long history of postural headache, tinnitus and vertigo, was admitted for diagnostic work-up and subsequently diagnosed with SIH. Magnetic resonance imaging showed signs of intracranial hypotension and several meningeal diverticula in the region of the nerve roots spanning from the lower cervical to the lower thoracic level (C7-T10) –see figure 1. After ruling out overt leakage of CSF from other locations, a causal association between the meningeal diverticula and SIH was assumed.

Results Being non-responsive to previous conservative measures (bed rest, abundant oral hydration and caffeine 600mg/day), an epidural blood-patch (EBP) was requested to the anaesthesiology team. An EBP was performed at T9-T10 level with 20 ml of autologous blood, without complications.

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Abstract EP173 Figure 1

Magnetic resonance image showing several meningeal diverticula, signaled by arrows

Conclusions The result was complete resolution of symptoms in a few hours, with asymptomatic ambulation and hospital discharge within 24 hours.