A Rare Case of Spontaneous Intracranial Hypotension Secondary to C4-C5 and T12 Dural Tears Following a Yoga Class

Spontaneous intracranial hypotension (SIH) is a potentially debilitating condition caused by cerebrospinal fluid (CSF) leakage through dural tears, leaking meningeal diverticula, or CSF-venous fistulae. This case report describes two yoga-induced dural tears leading to spontaneous SIH. Diagnosing SIH due to dural tears and CSF leaks can be challenging, but magnetic resonance imaging (MRI) aids in confirmation. A woman in her 30s presented to the Emergency Department with a three-week history of sudden, right-sided orthostatic headache following a yoga session, accompanied by tinnitus, visual disturbances, and vomiting. A head and C-spine MRI, including a high-resolution constructive interference in steady state sequence, revealed pachymeningeal enhancement and dural tear at the C4/C5 interspinous process region. Despite conservative management and epidural blood patches, surgical intervention was required to treat the CSF leaks. This report underscores the importance of clinician awareness regarding yoga-associated SIH. Prompt diagnosis and accurate radiological assessment are crucial, and educating patients about the risks during yoga can aid in early detection and treatment.