When the Head Only Works When Lying Down: A Case Report

Headaches can have many causes. The causes can be very common but can also have a rare etiology. Therapy is the treatment of the respective etiology. Certain symptoms, so-called red flags, can prompt the general practitioner to act more quickly. The case report is about a 67-year-old patient who suffered from headaches, fatigue and nausea. The symptoms disappeared when lying down and only occurred when standing. An magnetic resonance imaging (MRI) of the skull was ordered. This showed hygromas of the cerebral hemispheres, which were caused by cerebrospinal fluid loss. A MR - myelography was performed, which showed cerebrospinal fluid loss at the level of thoracic vertebrae 11 and 12. The clinical symptoms and the imaging findings led to the diagnosis of spontaneous cerebrospinal fluid loss syndrome. Treatment was carried out by neurosurgical leak closure. The patient became symptom-free after the therapy. Intracranial hypotension is usually caused by loss of cerebrospinal fluid. Early detection is important for treatment and reduction of further complications. PEER REVIEWED ARTICLE Peer Reviewers: Prof. Dr Andreas Gantenbein, Rehaclinic Bad Zurzach One anonymous peer reviewer Received on August 19, 2024; accepted after peer review on September 19, 2024; published on October 30, 2024.