Spontaneous intracranial hypotension (SIH) is characterized by positional headache caused by low CSF pressure, without any major traumatic event. Optimal treatment is still debated; epidural blood patch (EBP) is usually used after unsuccessful conservative treatment with variable efficacy and potentially severe complications. Although steroids have been reported to be beneficial, their effectiveness is still controversial, and more clinical evidence is needed. A 37-year-old woman was admitted to the neurology department due to severe orthostatic headache with nausea over the last 5 days. No trauma history or spinal manipulation were mentioned. On arrival, neurological examination, brain CT, and laboratory investigation were normal. Intracranial hypotension was clinically suspected, and lumbar puncture revealed low opening pressure. Brain MRI demonstrated pachymeningeal gadolinium enhancement and distended and rounded dural venous sinuses, while cervicothoracic spine MRI revealed thoracic CSF leakage, leading to SIH diagnosis. The patient was treated with high-dose intravenous methylprednisolone, with complete clinical resolution within 24 h. Our case, combined with literature evidence, supports the high-dose intravenous corticosteroids as a reasonable treatment option in selected cases, before trying EBP or surgical repair. Randomized clinical trials are needed, in order to optimize SIH patients’ outcomes.

中文翻译：

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皮质类固醇治疗自发性颅内低血压：病例报告和重点回顾病理生理学和治疗

自发性颅内低血压（SIH）的特点是由低脑脊液压力引起的位置性头痛，没有任何重大创伤事件。最佳治疗方案仍有争议。硬膜外血补片（EBP）通常在保守治疗不成功后使用，具有可变的疗效和潜在的严重并发症。尽管据报道类固醇是有益的，但其有效性仍存在争议，需要更多的临床证据。一名 37 岁女性在过去 5 天内因严重的体位性头痛和恶心入院神经内科。未提及外伤史或脊柱操作。抵达时，神经系统检查、脑部 CT 和实验室检查均正常。临床怀疑颅内低血压，腰椎穿刺显示低开口压。脑部 MRI 显示硬脑膜钆增强和扩张和圆形的硬脑膜静脉窦，而颈胸椎 MRI 显示胸椎 CSF 渗漏，导致 SIH 诊断。患者接受大剂量静脉注射甲基强的松龙治疗，24 小时内临床完全缓解。我们的案例结合文献证据，支持在尝试 EBP 或手术修复之前，高剂量静脉注射皮质类固醇作为特定病例的合理治疗选择。需要随机临床试验，以优化 SIH 患者的结果。在 24 小时内具有完全的临床分辨率。我们的案例结合文献证据，支持在尝试 EBP 或手术修复之前，高剂量静脉注射皮质类固醇作为特定病例的合理治疗选择。需要随机临床试验，以优化 SIH 患者的结果。在 24 小时内具有完全的临床分辨率。我们的案例结合文献证据，支持在尝试 EBP 或手术修复之前，高剂量静脉注射皮质类固醇作为特定病例的合理治疗选择。需要随机临床试验，以优化 SIH 患者的结果。