When does too little pressure become too much? A case of spontaneous intracranial hypotension presenting with acute loss of consciousness

Background: We present a unique case of spontaneous intracranial hypotension (SIH) presenting with acute collapse and loss consciousness. Case Description: The affected patient suffered an abrupt decline in level consciousness several weeks after initial diagnosis. was urgently transferred to specialist neurosurgical unit. Imaging showed bilateral subdural fluid collections significant associated local mass effect. treating team faced clinical conundrum lack clarity as whether this sudden deterioration secondary the pressure effect on brainstem traction from reduced pressure. A decision made proceed urgent burr-hole decompression collections. Conclusion: After protracted, complex postoperative course, recovered full functional independence. To author’s knowledge, is first literature describing successful surgical management SIH, evacuation relieve paradoxical