Abstract text (incl. figure legends and references)
Spontaneous intracranial hypotension (SIH) is characterized by a low cerebrospinal fluid (CSF) volume because of leakage, resulting in an orthostatic headache.1 Little is known about SIH during pregnancy, especially in a third-trimester is very rarely reported.2 We report a SIH case in a third-trimester pregnant woman, which was resolved by delivery.This is the first report to our knowledge.
A 30-year-old woman at 33+6 weeks" gestation presented to our hospital with a headache. She had felt a tearing pain in the upper back while mopping 4 days ago, then an orthostatic headache occurred. Diffuse pachymeningeal thickening/enhancement and fluid collection near the dura showed on brain and spine MRI. (Fig. 1 & 2) We diagnosed her with SIH clinically. She had been treated with bed rest, hydration, and analgesics, but did not improve. We inquired obstetricians about fetal safety for the CT-guided epidural blood patch (EBP), and they recommended a procedure after delivery because the fetus was mature. She had a cesarean section.
The headache rapidly improved after the delivery. On the third day after delivery, the patient could stand for more than an hour. She was discharged on the fifth day after delivery without a headache.
Although the risk or physiologic factors for SIH during pregnancy are unknown, the point that SIH was resolved through delivery in this case suggests that SIH might be related to pregnancy itself. If the symptom does not improve with known treatment, delivery might be considered as the next option for treatment when the fetus matures allow delivery.
1. Mokri B. Spontaneous intracranial hypotension.Continuum.2015;21:1086-108
2. Ferrante E, et al. Management of Spontaneous Intracranial Hypotension During Pregnancy: A Case Series.Headache.2020;60:1777-87
Figure 1. Brain MRI show diffuse pachymeningeal thickening and enhancement.
Figure 2. Spine MRI show diffuse fluid collection in the epi and subdural space, posterior to the C7-T7 cord. (arrows)