Disclosures: Kyla Kosidowski: No financial relationships or conflicts of interest

Case Diagnosis: 33-year-old male with postural headaches secondary to midbrain herniation and Chiari 1 Malformation caused by noniatrogenic spontaneous CSF leak and cervicothoracic pseudomeningocele

Case Description or Program Description: The patient first presented to clinic with worsening headaches over the course of 4 months aggravated by left lateral bending, cervical extension, turning the head rightward, going to the bathroom, and standing. The patient had no history of head trauma and was treated with occipital nerve block and oral steroids with only half day relief. He presented to the ED 2 weeks later and cervical brain MRI demonstrated intracranial hypotension, midbrain herniation and Chiari 1 Malformation secondary to spontaneous CSF leak with cervicothoracic meningocele. Blood patch was performed with autologous blood into the epidural space at L1/L2 and headache resolved. The patient followed up with neurology without any significant events until 2 years later when he experienced recurrence of symptoms. Repeat MRI was consistent with CSF leak. Lumbar epidural blood patch was performed and patient experienced symptom relief.

Setting: Tertiary care hospital and outpatient clinic

Assessment/Results: The patient’s symptoms were resolved for 2 years following blood patch. Upon recurrence of CSF leak, epidural blood patch was performed and patient’s symptoms improved immediately. The patient continues to follow up with neurology.

Discussion (relevance): This is the first reported case, to our knowledge, of postural headaches secondary to midbrain herniation and Chiari malformation caused by noniatrogenic spontaneous CSF leak with cervicothoracic pseudomeningocele.

Conclusions: Postural headaches secondary to noniatrogenic spontaneous CSF leaks can occur in otherwise healthy young patients. Though an unusual cause of headache, one needs to look further when the headaches are postural.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-33-year-old-male-with-postural-headaches-secondary-to-midbrain-herniation-and-chiari-1-malformation-caused-by-noniatrogenic-spontaneous-csf-leak-and-cervicothoracic-pseudomeningocele/