7.2.3 Headache attributed to spontaneous intracranial hypotension

Identification: Sex/Age: Male, 42 years Medical History: Healthy, regular weightlifting Habits: Non-smoker, social alcohol consumption History of Present Illness (HPI): Main symptom: Severe headache for 1 week Pain characteristics: Location: Bifrontal and occipital Character: Intense pressure Intensity: 9/10 in orthostasis Complete relief in the supine position (15-20 minutes) Progressive worsening throughout the day Associated symptoms: Nausea (without vomiting) Mild photophobia Bilateral pulsatile tinnitus Transient blurred vision upon standing Physical/Neurological Examination: General: Conscious, oriented Neurological: No focal deficits Normal and symmetrical reflexes Valsalva maneuver exacerbating headache Mild pain on cervical flexion Complementary Examinations: Cranial MRI: Diffuse meningeal enhancement post-contrast Descent of cerebellar tonsils (5mm below the foramen magnum) Intracranial venous dilation Total Spine MRI: Extradural fluid collection at T6-T8 Signs of CSF leakage