J Clin Neurol.  2008 Jun;4(2):89-93. 10.3988/jcn.2008.4.2.89.

Pneumocephalus in Patients With Orthostatic Headache

  • 1Department of Neurology, Eulji University College of Medicine, Daejeon, Korea. trumind@lycos.co.kr
  • 2Department of Radiology, Eulji University College of Medicine, Daejeon, Korea.


Cerebrospinal fluid (CSF) leak or shunt overdrainage is a well-known cause of orthostatic headaches and low CSF pressures. We report two cases of orthostatic headache with pneumocephalus on brain imaging. The orthostatic headache developed after drainage of spinal operation site and epidural block. Brain MRI revealed characteristic findings of CSF hypovolemia including pachymeningeal enhancement and mild subdural fluid collections. Air was also observed in the ventricular or subarachnoid space in both patients, which might enter the subarachnoid or ventricular space during a procedure via the pressure gradient or an injection.


Orthostatic headache; Pneumocephalus; CSF hypovolemia
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