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  <Article>
    <Journal>
      <PublisherName>jmedicalcasereports</PublisherName>
      <JournalTitle>Frontiers in Medical Case Reports</JournalTitle>
      <PISSN>I</PISSN>
      <EISSN>S</EISSN>
      <Volume-Issue>Volume 2; Issue 6</Volume-Issue>
      <PartNumber/>
      <IssueTopic>Multidisciplinary</IssueTopic>
      <IssueLanguage>English</IssueLanguage>
      <Season>(Nov-Dec, 2021)</Season>
      <SpecialIssue>N</SpecialIssue>
      <SupplementaryIssue>N</SupplementaryIssue>
      <IssueOA>Y</IssueOA>
      <PubDate>
        <Year>-0001</Year>
        <Month>11</Month>
        <Day>30</Day>
      </PubDate>
      <ArticleType>Medical Case Reports</ArticleType>
      <ArticleTitle>Spontaneous Intracranial Hypotension: An Unusual Debut and An Exceptional Evolution</ArticleTitle>
      <SubTitle/>
      <ArticleLanguage>English</ArticleLanguage>
      <ArticleOA>Y</ArticleOA>
      <FirstPage>1</FirstPage>
      <LastPage>7</LastPage>
      <AuthorList>
        <Author>
          <FirstName>Cristina del</FirstName>
          <LastName>Toro-Pérez</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>N</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Pedro Guardado</FirstName>
          <LastName>Santervás</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Patricia</FirstName>
          <LastName>Martínez-Sánchez</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Antonio</FirstName>
          <LastName>Arjona-Padillo</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
        </Author>
      </AuthorList>
      <DOI/>
      <Abstract>Spontaneous intracranial hypotension (SIH) is an entity that requires a high level of suspicion in order to request specific tests for its detection. However, its wide clinical variability can make it difficult to diagnose. The objective of this case report is to review several features of SIH through two atypical clinical cases; the first one with an atypical debut and the second one with an unexpected clinical evolution.&#13;
&#13;
The first patient presents with a focal seizure due to cerebral venous sinus thrombosis without headache attributable to hypotension, being later diagnosed following neuroimaging. The second patient presents with a characteristic picture of SIH with initial response to treatment. However, he undergoes an unusual subsequent evolution with the final diagnosis of Primary Central Nervous System Lymphoma, which makes it necessary to consider this disease as a possible etiology of SIH, a relationship not described to date in the literature.&#13;
&#13;
The two atypical cases of SIH demonstrate that thanks to a better understanding of this entity it is possible to diagnose patients without the classic clinical presentation. Once the diagnosis is established, it is important to be alert to the possibility of an unusual clinical course.</Abstract>
      <AbstractLanguage>English</AbstractLanguage>
      <Keywords>Intracranial Hypotension,Cerebrospinal Liquid Leak,Epilepsy,Headache,Nausea,Orthostatic Spontaneous,Subdural Hematoma,Thrombosis,Primary Central Nervous System Lymphoma,Case report</Keywords>
      <URLs>
        <Abstract>https://www.jmedicalcasereports.org/ubijournal-v1copy/journals/abstract.php?article_id=13400&amp;title=Spontaneous Intracranial Hypotension: An Unusual Debut and An Exceptional Evolution</Abstract>
      </URLs>
      <References>
        <ReferencesarticleTitle>References</ReferencesarticleTitle>
        <ReferencesfirstPage>16</ReferencesfirstPage>
        <ReferenceslastPage>19</ReferenceslastPage>
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Mokri B (2013) Spontaneous Low Pressure, Low CSF Volume Headaches: Spontaneous CSF Leaks. Headache 2013; 53: 1034-1053&#13;
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Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics 2007; 27: 525-551&#13;
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Wesley SF, Garcia-Santibanez R, Liang J, Pyburn D. Incidence of meningeal enhancement on brain MRI secondary to lumbar puncture. Neurol Clin Pract 2016; 6: 315–320&#13;
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Zhang D, Wang J, Zhang Q, He F, Hu X. Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension: A Report on 4 Cases and a Review of the Literature. Headache 2018; 58: 1244-1255.</References>
      </References>
    </Journal>
  </Article>
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