Algorithm-based diagnosis and targeted epidural blood patch for spontaneous intracranial hypotension: a case report from a Vietnamese tertiary center

Abstract Background Spontaneous intracranial hypotension (SIH) is an increasingly recognized disorder caused by spinal cerebrospinal fluid (CSF) leakage. Although characteristic brain magnetic resonance imaging (MRI) findings may suggest the diagnosis, precise localization of the leak often requires advanced imaging techniques. Reports describing the application of contemporary SIH diagnostic algorithms in Southeast Asia remain limited. Case presentation A 40-year-old Japanese woman presented with severe orthostatic headache and vertigo after heavy lifting and excessive neck rotation. Brain MRI demonstrated diffuse pachymeningeal enhancement, venous sinus engorgement, and brain sagging, yielding a Bern SIH score of 7 and indicating a high probability of spinal CSF leakage. Whole-spine MRI revealed a spinal longitudinal epidural CSF collection extending from T1 to T12. Based on the positive SLEC pattern, prone dynamic CT myelography was performed and identified a thoracic ventral dural tear at the T2 level. Targeted epidural blood patching was subsequently performed using 4 mL of autologous blood. Follow-up MRI demonstrated marked reduction of the epidural fluid collection and re-expansion of the thecal sac. The patient experienced gradual clinical improvement and was discharged with significant symptom relief. Conclusions This case illustrates the clinical value of a structured multimodality imaging approach for SIH, integrating the Bern SIH score, whole-spine MRI, and dynamic CT myelography to guide targeted treatment. Accurate leak localization enabled successful targeted epidural blood patching and favorable clinical recovery. Furthermore, this report demonstrates the feasibility of implementing advanced SIH diagnostic and interventional techniques in a Vietnamese tertiary-care hospital.