The domino effect of acephalgic spontaneous intracranial hypotension

Umberto Pensato, Fabrizio Giammello, Tommaso Baldini, Anna Zaniboni, Laura Piccolo, Giorgia Arnone, Mauro Gentile, Luigi Cirillo, Luigi Simonetti, Salvatore Isceri, Andrea Zini

Research output: Contribution to journalArticlepeer-review


Spontaneous intracranial hypotension results from a spinal CSF leak and usually presents with orthostatic headache, although acephalgic presentations have anecdotally been reported. The underlying low CSF volume, rarely, leads to serious complications such as cerebral venous thrombosis and coma. We report a patient presenting with cerebral venous thrombosis secondary to acephalgic spontaneous intracranial hypotension. An epidural blood patch was performed; nonetheless, the patient intracracal condition deteriorated to coma and neuroimages showed a deep brain swelling with midbrain distortion, subsequently complicated by intracranial pontine hemorrhage.

Original languageEnglish
JournalNeurological Sciences
Publication statusAccepted/In press - 2020


  • Cerebral venous thrombosis
  • CSF leak
  • Deep brain swelling
  • Epidural blood patch
  • Midbrain swelling
  • Orthostatic headache

ASJC Scopus subject areas

  • Dermatology
  • Clinical Neurology
  • Psychiatry and Mental health


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