Abstract
IntroductionA spinal cerebrospinal fluid leak is the most common cause of spontaneous intracranial hypotension which is an uncommon but increasingly recognized cause of headache. This article describes the first reported case of pilates being associated with a spontaneous spinal cerebrospinal fluid leak whilst also highlighting the key information about spontaneous cerebrospinal fluid leaks that will be useful to the general clinician.Case presentationWe present the case of a 42-year-old Caucasian woman who developed a low-pressure headache following a pilates class. A computed tomography scan of her head demonstrated bilateral chronic subdural hematomas and cerebellar descent. Magnetic resonance imaging of her spine revealed the presence of extensive extradural cerebrospinal fluid collections. She responded to conservative management and repeat neuroimaging after symptom resolution revealed no abnormalities.ConclusionsAwareness and early recognition of spontaneous intracranial hypotension is important to prevent unnecessary investigations and delay in treatment. Pilates may be a risk factor for the development of a spontaneous cerebrospinal fluid leak.
Highlights
A spinal cerebrospinal fluid leak is the most common cause of spontaneous intracranial hypotension which is an uncommon but increasingly recognized cause of headache
This article describes a case of Spontaneous intracranial hypotension (SIH) secondary to a spontaneous spinal cerebrospinal fluid (CSF) leak in a patient who attended ‘pilates reformer’ classes
Subdural hematomas are common in patients with SIH and are usually bilateral but without mass effect [1]
Summary
The most common cause of SIH is a spontaneous spinal CSF leak and MRI findings in these patients include pachymeningeal enhancement, downward displacement of the brain and subdural hematomas. This case highlights the need for increased awareness and early recognition of SIH in order to prevent unnecessary investigations and delay in treatment. Most importantly, this case raises the possibility of pilates being a risk factor for the development of a spontaneous CSF leak. Author details 1Department of Gastroenterology, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. Author details 1Department of Gastroenterology, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. 2Department of Neurology, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
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