Spontaneous Intracranial Hypotension Can be the Presenting Manifestation of Grave’s Disease: A Case Report

Introduction: Autoimmune thyroid disorders are known to cause various neurological manifestations, however spontaneous intracranial hypotension (SIH) is an extremely rare association and to the best of our knowledge this is the first report describing SIH to be presenting manifestation of Graves’ disease. Case presentation: We report the case of a middle-aged lady who presented with spontaneous intracranial hypotension secondary to Graves’ disease. A 43 -year -old Arab lady presented with subacute onset orthostatic headache, vomiting and dizziness followed by blurring of vision and diplopia. Investigations and outcome: Brain and spine imaging was suggestive of spontaneous intracranial hypotension. Lab investigations revealed hyperthyroidism with elevated anti TSH (thyroid stimulating hormone) receptor antibodies confirming diagnosis of Graves’ disease. She was managed conservatively for the orthostatic headache and was started on anti-thyroid medications. She was asymptomatic at 3months follow up. Conclusion: Thyroid disorders should be looked for in patients presenting with intracranial hypotension since correcting the underlying thyroid dysfunction may help correcting the intracranial pressure changes thus preventing recurrence of headache.