Spontaneous intracranial hypotension: A case study

Purpose: To present an illustrative case study of a patient with spontaneous intracranial hypotension (SIH) and to increase awareness of this condition among nurse practitioners (NPs). Data sources: A literature search was conducted, and deidentified patient information forms the basis of this presentation. The authors experience and appropriate images enhance the presentation of the case study. Conclusions: SIH is a condition that typically occurs without a traumatic event, although it can be associated with minor trauma. It occurs when cerebrospinal fluid (CSF) leaks through a focal weakness in the dural sac or meningeal diverticula, resulting in CSF hypovolemia. Patients usually present with an orthostatic headache. The most common brain magnetic resonance imaging findings are diffuse pachymeningeal enhancement, descent of the cerebellar tonsils, and subdural fluid collections. Treatment options range from management of symptoms to surgical repair of the leak. Implications for practice: As NPs continue to provide care in a variety of settings, including emergency departments and urgent care areas, they must be familiar with the progression of symptoms that might indicate SIH and be prepared to make appropriate referrals to prevent iatrogenic morbidity.