Unexplained Headache After Surfing: Diagnosis of a Spinal Cerebrospinal Fluid Leak

A 35-year-old woman developed a severe orthostatic headache following a surfing trip. Initial work-up, including blood tests and computed tomography scans of the brain, was unremarkable. She was initially misdiagnosed with viral meningitis owing to a positive enterovirus result on a respiratory viral panel. Persistent symptoms prompted magnetic resonance imaging of the brain and spine, which revealed intracranial hypotension and a spinal cerebrospinal fluid (CSF) leak. Her symptoms resolved after an epidural blood patch. This case highlights the diagnostic challenges of spontaneous spinal CSF leaks and emphasizes the importance of early recognition, particularly in patients presenting with postural (orthostatic) headaches after recent mechanical stress, such as surfing.