Intracranial hypotension secondary to spinal pathology: Diagnosis and treatment

•Disc herniations and osteophytes can be a potential cause of dural tear and intracranial hypotension.•Classic findings of intracranial hypotension include orthostatic headaches and smooth pachymeningeal enhancement.•Epidural blood patch can be an effective treatment for intracranial hypotension secondary to spinal pathology.

Spinal pathology resulting in cerebrospinal fluid (CSF) leak and intracranial hypotension is an infrequently reported and a potentially severe cause of headaches. We present a case of cerebrospinal fluid (CSF) leak caused by a thoracic disk herniation successfully treated with two targeted epidural blood patches. Although patients typically present with orthostatic headaches, the imaging findings of intracranial hypotension should prompt investigation of the spine for site and cause of the CSF leakage. Treatment includes autologous blood patch and surgery in refractory cases.