Audiovestibular symptoms in spontaneous intracranial hypotension: Cues from two cases

Spontaneous intracranial hypotension (SIH) is a rare condition that usually presents with posterior headache. A high percentage of patients with SIH experience audiovestibular symptoms, including vertigo, tinnitus, and hearing fluctuations. This pattern of symptoms is very similar to that observed in Ménière’s disease; therefore, in selected cases, it is necessary to suspect SIH to formulate the correct diagnosis. Two patients with SIH and audiovestibular symptoms were studied at the Otolaryngology and Audiology Department of the University Hospital of Ferrara. Both the patients underwent audiometric testing, vestibular assessment, brain and spine magnetic resonance imaging (MRI) with contrast, neurosurgical evaluation, and treatment. A 75-year-old patient and a 53-year-old patient were referred to our center for vertigo exacerbated by postural changes, auditory fluctuations, and headache. In both the cases, contrast-enhanced brain MRI allowed to formulate the diagnosis of SIH, which was then confirmed by spinal MRI. Conservative treatment was attempted in both the patients, first, without therapeutic success; therefore, an epidural blood patch was p erformed with good control of symptoms. SIH is a rare condition that may present with symptoms similar to Ménière’s disease; in selected cases, it is necessary to suspect an SIH, and a multidisciplinary approach, including a neuroradiological and a neurosurgical evaluation, is fundamental for the correct and timely diagnosis and intervention.