Headache associated with cerebrospinal fluid hypotension. Secondary headache with dura mater osteophyte perforation at the Th6-Th7 level: A case report

Introduction. Currently, it is believed that most cases of spontaneous intracranial hypotension result from a spontaneous leakage of cerebrospinal fluid. The estimated prevalence among the population ranges from 1 in 50,000 to 1 in 20,000 cases of spontaneous cerebrospinal fluid leakage occurring in emergency departments. A typical patient is usually middle-aged with complaints of orthostatic headaches associated with low cerebrospinal fluid volume and pressure with no history of any interventions or injuries. Aim. To describe the diagnostic search for possible causes of the patient’s orthostatic headache. Materials and Methods. A clinical case is described of a patient with secondary headache associated with dura mater osteophyte perforation at the Th6-Th7 level. Results and Discussion. Female patient S., 38 years old, complaining of a bilateral persistent headache accompanied by tinnitus and back pain, appeared in the admission department of City Clinical Hospital No. 7 named after M. N. Sadykov. It is known from the medical history that upon lifting a weight, the patient developed back pain, and later had a headache. Conservative NSAID therapy at the outpatient stage proved ineffective. During her hospitalization in the neurological department, the patient underwent some diagnostic tests, including CT scanning her thoracic spine, ultrasound of the paravertebral muscles, MRI of the cervical and thoracic spine with contrast enhancement, and a consultation with physicians, as a result of which thhe final diagnosis was made. Conclusion. The clinical case above demonstrates the need for a full-fledged collection of complaints and medical history, as well as a complete neurological examination.