A 40-year-old woman presented with worsening headache accompanied by vomiting, anorexia, and tinnitus. The headaches were initially orthostatic. MRI showed chronic progressive subdural hematomas (SDH) with significant mass effect, diffuse pachymeningeal enhancement, and pituitary enhancement/enlargement (figure, A and B), indicating intracranial hypotension due to spontaneous spinal CSF leak, which was confirmed by CT myelography (figure, C). CSF leak is an important cause of SDH,1 which, by clinical and radiologic manifestations, may give the false impression that the patient has intracranial hypertension but without papilledema or hydrocephalus, termed pseudo-intracranial hypertension. This recognition is crucial because both conservative measures to decrease intracranial pressure and evacuation of the SDH are harmful.1,2
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