- To appreciate atypical clinical features of severe spontaneous intracranial hypotension

- To appreciate radiologic findings of intracranial hypotension as well as false-localizing signs of cerebrospinal fluid leak

Spontaneous intracranial hypotension is a rare condition resulting from a leak of cerebrospinal fluid (CSF) which can affect individuals of all ages without a preceding trigger or risk factor. Presentation classically includes postural headache, but a variety of other neurological manifestations including tinnitus, vertigo, and ataxia have been described. Imaging findings typically help establish the diagnosis, but identification of the source of CSF leak and treatment using blood patch, surgery, or endovascular intervention can be challenging. Here we describe a case of severe spontaneous intracranial hypotension presenting with intractable hiccups.

Intracranial hypotension is a rare condition resulting from CSF leak that is associated with a variety of cerebellar and brainstem signs. Hiccups are a rarely described finding that can indicate a more severe insult to the CNS and should prompt escalation of level of care. Urgent localization of the CSF leak and subsequent patching or repair is vital to prevent further decline in these patients.