Spontaneous intracranial hypotension (SIH) is a rare and often underdiagnosed condition, which commonly results from a
cerebrospinal fluid leak. The classic clinical presentation of SIH is a postural
headache and
dizziness. Less frequent complications include
nausea, neck stiffness, and even
coma. This case report describes a 70-year-old woman with an initial complaint of postural
headaches and sleep attacks, who developed a 22-month progressive history of personality and behavioral changes,
cognitive decline,
urinary incontinence,
chorea, and
dysarthria. Although no specific
cerebrospinal fluid leak was identified, the patient was suspected of having SIH and her symptoms completely reversed after a 2-month course of
steroids. This case highlights that SIH represents a rare and reversible cause of a wide spectrum of neurological symptoms, including
dementia. Neurologists should be aware of this diagnosis when evaluating patients with neurological signs and symptoms that cannot otherwise be explained.