Rayane Bekkaoui, Chaimaa Chemachi, Salma Tabati, Hamza Retal, Najwa Ech-cherif Kettani, Meriem Fikri, Firdaous Touarsa
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 10
Date of Publication: 2026/10/08
Spontaneous intracranial hypotension (SIH) is most commonly related to spontaneous spinal cerebrospinal fluid (CSF) loss and typically presents with orthostatic headache. We report the case of a 48-year-old woman with a three-month history of orthostatic headaches associated with vomiting and dizziness who subsequently developed binocular diplopia due to a right abducens nerve palsy. Cerebral MRI demonstrated characteristic features of SIH, including pachymeningeal enhancement, pituitary engorgement, and deep venous distension. Whole-spine MRI revealed a predominantly ventral spinal longitudinal extradural CSF collection extending from C6 to L3. Post-contrast coronal 3D STIR-SPACE imaging further demonstrated a diverticular abnormality of the right C7 nerve root sleeve with an associated fluid tract consistent with CSF leakage, supporting the diagnosis of a type 2 lateral spinal CSF leak. No invasive myelographic examination was performed, and the patient was referred for neurosurgical evaluation. This case highlights delayed abducens nerve palsy as an uncommon manifestation of SIH and illustrates the potential role of tailored high-resolution spinal MRI in noninvasive leak localization when the source is directly visualized.
Spontaneous intracranial hypotension, spinal cerebrospinal fluid leak, abducens nerve palsy, meningeal diverticulum, T2-SPACE MRI
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