7.2.3 Headache attributed to spontaneous intracranial hypotension

Identification: Sex/Age: Female, 38 years. Medical History: Healthy, no medication use or recent trauma history. History of Present Illness (HPI): Main symptom: Severe headache for 4 days, sudden onset. Pain characteristics: Location: Frontal and occipital. Character: Deep, "pressure-like." Intensity: 8/10. Trigger: Marked worsening in the upright position (standing/sitting) and significant improvement when supine (within 15-30 minutes). Associated symptoms: Nausea, mild neck stiffness, and pulsatile tinnitus. Physical/Neurological Examination: General: Preserved consciousness. Neurological: No motor or sensory deficits. Normal reflexes, no overt meningeal signs. Mild postural hypotension (BP: 100/60 mmHg standing vs. 120/80 mmHg lying down). Complementary Exams: Cranial + Spinal MRI: Typical findings: Diffuse thickening and post-contrast enhancement of the meninges. Descent of the cerebellar tonsils (low position). Epidural fluid collection in the thoracic spine (suggestive of CSF leak). Lumbar Puncture (if performed): Low opening pressure (<6 cmH₂O).