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Anthony S.-I. Pakiam, MD; Christine Lee, MD; Anthony E. Lang, MD

Arch Neurol. 1999;56:869-872.

Objective  To describe a case of spontaneous intracranial hypotension with a previously unreported constellation of presenting features.

Design  Case report.

Setting  Tertiary care center.

Main Outcome and Results  We describe a patient with intracranial hypotension who presented with a parkinsonian syndrome and later development of ataxia and prominent bulbar symptomatology. Headache was not a feature of her initial presentation and was only reported after repeated questioning during later evaluations. Magnetic resonance imaging of the patient's head revealed findings characteristic of intracranial hypotension. An [¹⁸F]fluoro-m-tyrosine positron emission tomographic scan showed normal striatal activity, suggesting intact presynaptic nigrostriatal function. Opening pressure on lumbar puncture was reduced at 40 mm H₂O. A source of cerebrospinal fluid leakage was not identified on nuclear cisternography and the patient underwent lumbar epidural blood patching, which resulted in complete resolution of her signs and symptoms as well as in a marked improvement in her imaging findings.

Conclusions  The clinical spectrum of intracranial hypotension can be broadened to include parkinsonism, cerebellar ataxia, and prominent bulbar dysfunction. As with more common manifestations of the disorder, these features may resolve after appropriate treatment.

From the Division of Neurology (Drs Pakiam and Lang) and the Department of Medicine (Dr Lee), Toronto Western Hospital, Toronto, Ontario.

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