Intracranial Hypotension or Intracranial Hypertension?: A Case Caught in Transition

Spontaneous intracranial hypotension (SIH) has been known to occur with an underlying structural weakness of the spinal or skull base meninges and has been associated with a postural headache, neck pain, nausea, and vomiting (1). There is increasing evidence that idiopathic intracranial hypertension (IIH) may also cause spontaneous cerebral spinal fluid (CSF) leaks (classified as highpressure leaks) and thus SIH that prevents overt manifestations of IIH unless the underlying CSF leak is treated (2,3). Accordingly, rebound intracranial hypertension has been shown to occur following treatment of intracranial hypotension, commonly with epidural blood patching (EBP) or surgical repair of the leak (2,4). We present a patient with MRI and clinical evidence of SIH spontaneously transitioning into IIH.