Abstract

Spontaneous intracranial hypotension rarely occurs at upper cervical level. A 55-year-old man was admitted to hospital for orthostatic headache, neck pain, nausea and vomiting for 2 weeks. Brain MRI showed a subdural hematoma in the bilateral fronto-temporo-parietal region and diffuse dural enhancement. Radioisotope cisternography revealed CSF leakage at upper cervical and thoracic vertebral level. The patient was successfully treated with C-arm-guided epidural blood patch at the C3-4 level after the patient had failed first epidural blood patch at thoracic level.