Kasner S E, Rosenfeld J, Farber R E
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Headache. 1995 Oct;35(9):557-9. doi: 10.1111/j.1526-4610.1995.hed3509557.x.
Spontaneous intracranial hypotension is characterized by severe postural headache in the setting of low CSF pressure, usually attributed to a cryptic CSF leak. We report a patient whose prolonged refractory headache was characterized by the clinical symptoms of occipital neuralgia, but was also associated with the radiographic appearance of an Arnold-Chiari malformation, type I and low CSF pressure. After extensive diagnostic evaluation, CT cisternomyelography ultimately demonstrated a CSF leak at the C2 vertebral level. Symptomatic relief was sustained only with long-term theophylline administration. The apparent Arnold-Chiari malformation resolved with treatment of the low CSF pressure.
