Spontaneous epidural blood patch at T2/3 with resolution of intracranial hypotension

Background: Spontaneous intracranial hypotension (SIH) results from spinal cerebrospinal fluid (CSF) leakage and typically presents with orthostatic headache. Spontaneous resolution without intervention is rare, and its underlying mechanism has not been established. Case Description: A 33-year-old female developed a SIH following chiropractic manipulation. The magnetic resonance imaging (MRI) demonstrated a ventral CSF leak at the Th2/3 level. During conservative management, she experienced acute back pain coinciding with the formation of an epidural hematoma at the same level; her headache resolved promptly thereafter. Serial MRI scans showed gradual resorption of the hematoma without her incurring any new neurological deficit. Later, computed tomography myelography confirmed cessation of CSF leakage despite a persistent dural defect due to the spontaneous epidural hematoma. Conclusion: In a 33-year-old female, a spontaneous T2/3 epidural hematoma resulted in an endogenous blood patch that mechanically occluded a dural tear, causing SIH.