A case of traumatic intracranial hypotension caused by dural tear at C1 ⁄ C2

Abstract

A 70–year–old man fell off a stepladder and was promptly transported to the hospital. Five days after admission, he presented with orthostatic headache, and was diagnosed with cerebrospinal fluid (CSF) hypotension syndrome by contrast–enhanced magnetic resonance imaging (MRI). Due to the persistence of symptoms despite conservative treatment, and the subsequent development of hearing loss and chronic subdural hematoma, he was referred to our department. Epidural blood patch therapy failed to improve his symptoms. Based on the findings of the whole–spine MRI, we performed CT myelography targeting the upper cervical spine, which revealed contrast agent spreading into the extradural space on the left side of the C1 ⁄ C2 level, thereby localizing the CSF leakage site. Surgical dural repair was performed, resulting in symptomatic improvement. In case of treatment–resistant CSF hypotension, it is important to identify the precise leakage site utilizing multiple modalities.