Spontaneous Intracranial Hypotension Following a Yoga Class: A Case Report

Abstract

Spontaneous intracranial hypotension (SIH) is an underdiagnosed syndrome and initially missed cause of headaches. The classical presentation is that of an orthostatic headache, mainly caused by spontaneous and difficult to detect spinal CSF leaks. The current case report describes a 38 year old female patient who presented with symptoms following a Yoga class. Despite being initially misdiagnosed, her clinical course and radiological findings made it clear that she had intracranial hypotension syndrome with bilateral chronic subdural hematomas and cerebellar descent. She responded to surgical drainage of both her subdural hematomas and conservative management for her suspected CSF leak. This case, to our knowledge, is the first report in the literature of spontaneous intracranial hypotension being caused by a Yoga class. The report highlights the fact that some cases of SIH can be difficult to diagnose as their symptoms may be very confusing. Thorough interrogation of patients is vital, as trivial efforts and some exercising activities could be the cause of spontaneous dural tears. Early recognition is important to prevent unnecessary investigations and procedures, and to minimize delay in treatment.