Case Report
Delayed Cranial Progression of Pure Spinal Spontaneous Intracranial Hypotension: A Case Report
Ajit Kumar K*, Parameswaran K and Anand M
Department of Neurosurgery, Indo American Hospital Kerala, India.
*Corresponding author:Ajit Kumar K, Department of Neurosurgery, Indo American Hospital, Chemmanakary, Vaikom, Kottayam, Kerala, India. E-mail Id: dr.ajitkumar35@gmail.com
Article Information:Submission: 17/09/2026; Accepted: 05/10/2026; Published: 07/10/2026
Copyright: © 2026 Ajit Kumar K, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Spontaneous intracranial hypotension (SIH) typically presents with orthostatic headache and characteristic intracranial MRI features. A rare pure spinal variant exists in which both symptoms and imaging abnormalities are limited to the spine. Long-term outcomes of this subtype are poorly described.
Case Presentation: A 52-year-old male initially presented with progressive upper-limb weakness without orthostatic headache. Cranial MRI was normal, while spine MRI showed ventral epidural CSF collection and venous engorgement, consistent with pure spinal SIH. He remained clinically stable for nearly five years. He later developed sudden onset headache and vomiting; imaging revealed a subacute right convexity subdural hematoma with midline shift, indicating delayed cranial progression.
Conclusion: Pure spinal SIH may appear benign initially, but delayed cranial complications can occur years later. Long-term surveillance and early treatment may prevent serious outcomes such as subdural hematoma.
Case Presentation: A 52-year-old male initially presented with progressive upper-limb weakness without orthostatic headache. Cranial MRI was normal, while spine MRI showed ventral epidural CSF collection and venous engorgement, consistent with pure spinal SIH. He remained clinically stable for nearly five years. He later developed sudden onset headache and vomiting; imaging revealed a subacute right convexity subdural hematoma with midline shift, indicating delayed cranial progression.
Conclusion: Pure spinal SIH may appear benign initially, but delayed cranial complications can occur years later. Long-term surveillance and early treatment may prevent serious outcomes such as subdural hematoma.
Keywords:SIH; Orthostatic headache; Acute subdural hematoma