2025 American Academy of Neurology Abstract Website

Objective:

n/a

Background:

Idiopathic intracranial hypertension (IIH) following spontaneous skull base CSF leak repair is increasingly recognized, but only a few cases have been reported following repair of spontaneous spinal CSF leaks. We present a case of IIH developing six months after treatment of a presumed spinal CSF leak.

Design/Methods:

n/a

Results:

A 34-year-old female with a history of migraines and obesity presented with 3 months of positional headaches. MRI brain with and without contrast showed slit-like ventricles and low-lying cerebellar tonsils, concerning for intracranial hypotension. A CT myelogram did not identify a CSF leak. Opening pressure on lumbar puncture was 16 cm H2O. An epidural blood patch was performed with resolution of headaches.

Six months later, routine eye exam showed grade 4 disc edema in the right eye, and grade 3 disc edema in the left eye without sixth nerve palsies. She was asymptomatic. MRI brain and orbit revealed an empty sella and narrowing of the bilateral transverse sinuses. Repeat lumbar puncture revealed an opening pressure of 38 cm H2O and bland CSF analysis.

Optic coherence tomography (OCT) revealed an average retinal nerve fiber layer thickness of 643 microns in the right eye and 217 microns in the left eye. Humphrey visual field showed bilateral enlargement of her blind spots. CT scan of the temporal bones did not reveal skull base abnormalities or evidence of CSF leak. She never had otorrhea nor rhinorrhea.

Conclusions:

Most cases of rebound intracranial hypertension develop within one week following spinal CSF leak repair. The patient did not have evidence of skull base CSF leak, but was found to have intracranial hypertension six months after she was treated empirically with a blood patch for presumed spinal CSF leak. This case supports the idea that repair of spinal CSF leaks can be associated with idiopathic intracranial hypertension.