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- W599890275 abstract "BACKGROUND:Orthostatic headache is most commonly caused by cerebrospinal fluid leakage secondary to trauma to the dura in the spine. There have been 10 reported etiologies of orthostatic headache that were not caused by trauma to the dura, and only two were intracranial pathologies. Though meningioma is the most common primary brain tumor, it has never been reported to cause orthostatic headache. We would like to report the case of an intracranial meningioma causing orthostatic headache.CASE:A 54-year old woman with a 12 month history of orthostatic headaches presented to our clinic. Her exam was significant for left sided ptosis and asymmetric deep tendon reflexes, but was otherwise unremarkable. An MRI of the brain with contrast showed a large mass in the left frontal region consistent with a meningioma with marked mass effect, trapped right lateral ventricle, and downward transtentorial herniation. She underwent gross total resection with pathologically confirmed grade 1 meningioma, and her headaches subsequently resolved completely.DISCUSSION:We postulate that the orthostatic nature of the headache in this patient can be explained by worsening transtentorial cerebral herniation due to gravity, subsequently leading to traction of intracranial pain sensitive structures.CONCLUSIONS:Classically, headache secondary to an intracranial mass worsens in recumbency and improves with an upright position. However, in the right circumstance patients can present with paradoxical worsening in an upright position. Intracranial neoplasms should be considered in the differential diagnosis of orthostatic headaches and warrant cerebral imaging. Disclosure: Dr. Smith has nothing to disclose. Dr. Robertson has nothing to disclose. Dr. Garza has received personal compensation for activities with UpToDate as an author." @default.
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- W599890275 date "2015-04-06" @default.
- W599890275 modified "2023-09-23" @default.
- W599890275 title "New Etiology for Orthostatic Headache (P1.299)" @default.
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