• Christian Sass, Christoph Kosinski, Patrick Schmidt, Michael Mull, Jörg Schulz, and Johannes Schiefer.
• Department of Neurology, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. christian.sass@ukmuenster.de
• Neurocrit Care. 2013 Aug 1;19(1):116-8.

BackgroundSpontaneous intracranial hypotension (SIH) is a neurologic condition with the prototypical symptom of orthostatic headache. We report a dramatic case of SIH with life-threatening bilateral hygroma and uncal herniation.MethodsCase report.ResultsA 44-year-old male patient presenting with orthostatic headache and double vision was diagnosed with SIH. Diagnostic imaging showed meningeal enhancement and bilateral hygroma. A conservative treatment regime was initiated. The patient's condition rapidly deteriorated with progressive loss of consciousness. Cranial MRI showed beginning uncal herniation. As an emergency treatment measure, an intracranial pressure (ICP) probe was inserted and intrathecal lumbal saline infusion was initiated. This led to a stabilization of ICP and allowed further diagnostics and treatment.ConclusionIntrathecal lumbal saline infusion in combination with ICP monitoring can be a life-saving treatment option in unstable SIH patients.

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