Houdingsafhankelijke hoofdpijn door spontane intracraniële hypotensie

Klinische les
Mirjam E. Belderbos, G.J. (Hans) Amelink, Jan Willem Dankbaar en F.H.H. (Cisca) Linn

Dames en Heren,

Hevige, houdingsafhankelijke hoofdpijn, die verergert bij overeind komen en vrijwel verdwijnt bij liggen, kan passen bij spontane intracraniële hypotensie. Herkenning van dit zeldzame ziektebeeld is nodig om de patiënt tijdig te verwijzen voor diagnostiek en behandeling. Wanneer moet u aan intracraniële hypotensie denken, en hoe ontstaat deze aandoening?

Posture-dependent headache caused by spontaneous intracranial hypotension

A 36-year-old woman presented with a 3-4 month history of severe, progressive headache. The headache was characterized by postural variation, with excruciating headache in the upright position and near-immediate relief upon recumbence. There was no history of trauma or lumbar puncture. Gadolineum-enhanced brain MRI revealed abnormalities characteristic intracranial hypotension. Spinal MRI showed a longitudinal extradural fluid collection; a localization of the dural defect was not found. The patient was treated with caffeine, bed rest and lumbar epidural blood patches; she recovered completely. Severe orthostatic headache which aggravates upon standing and is relieved by recumbence, can be caused by spontaneous intracranial hypotension. Recognition of its characteristic symptoms is needed for timely referral. Treatment is usually successful and can prevent life-threatening complications.

Conflict of interest and financial support: none declared.