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In a rare neurological case, Manipal Hospital, Mukundapur, successfully diagnosed and treated Probir Guha, a 47-year-old, resident of Jadavpur, who had been suffering from persistent and severe headaches for over two and a half months. Under the expert care of Dr. Jayanta Roy, Director & Head – Neurology, the condition was diagnosed as Spontaneous Intracranial Hypotension (SIH), a disorder caused by a drop in cerebrospinal fluid (CSF) pressure (that cushions and protects the brain and spinal cord) due to a leak at the spine. The patient was treated using a minimally invasive procedure known as an autologous epidural blood patch by Dr. Indranil Ghosh, Consultant – Neuroanaesthesiology, Neurointensive Care, Pain and Palliative Care Specialist along with a surgery in brain performed by Dr. Dipendra Kumar Pradhan, Clinical Lead & Senior Consultant – Neurosurgery. The procedure involves injecting a small amount of the patients own blood near the site of the leak in the spine, which helps seal it, stop further fluid loss and enable rapid relief and recovery.



For over two and a half months, the patient suffered from intense headaches that severely affected his daily life, making it difficult for him to sit, work, or carry out routine activities. He consulted nearly 13 doctors across Kolkata from various specialties and underwent multiple CT and MRI scans, all of which returned normal results. Initially treated for migraine, he found no relief. A detailed consultation with Dr. Jayanta Roy revealed a crucial clue—the patients headache improved significantly when lying down but worsened upon sitting or standing. This unusual positional pattern raised suspicion of an underlying condition and prompted further investigation. The patient also recalled that his symptoms began after carrying a heavy backpack over a prolonged period. Further evaluation at Manipal Hospital, Mukundapur, identified a small tear in the dura, the outer protective covering of the spinal cord as the root cause, leading to leakage of cerebrospinal fluid (CSF), which normally cushions and supports the brain. The presence of this CSF leak was also confirmed through targeted spine imaging. The resulting loss of fluid reduced pressure inside the skull, causing the brain to shift slightly downward and strain surrounding nerves and blood vessels, leading to persistent and severe headaches. And the downward shift of brain caused a bleeding on the both the surfaces of the brain, further complicating the situation.



After the complete diagnosis the patient was subsequently treated a brain surgery to drain the blood along with an autologous epidural blood patch procedure, in which a small amount of his own blood was injected near the site of the spinal leak. The blood clotted and sealed the tear, stopping further leakage and restoring normal fluid pressure, leading to significant relief. The results were quick. The patient was discharged within two days of undergoing the procedure and is currently under regular follow-up and medication. He is doing well and has successfully resumed his normal routine and professional responsibilities.



Commenting on the case, Dr. Jayanta Roy said, “Headaches are often treated as routine conditions like migraine especially when initial scans are normal, but if they persist for a long time and do not respond to standard treatment, it is important to look deeper. In this case, the key clue was the positional nature of the headache it improved when the patient was lying down and worsened on sitting or standing, which is not typical of common headaches. Conditions like low cerebrospinal fluid pressure are uncommon and can be easily missed, especially when initial scans appear normal. This case highlights the importance of careful clinical evaluation and detailed history-taking, as identifying the right cause at the right time can lead to effective treatment and quick recovery.” It can be potentially dangerous and life threatening if the diagnosis is missed."



Sharing his experience, Probir Guha said, “Over the course of two and a half months, I consulted nearly 13 doctors across the city, yet the cause of my persistent pain remained undiagnosed. Despite my earlier reports appearing normal, Dr. Jayanta Roy sensed that something was not right and recommended further investigations. His timely intervention helped identify the underlying issue and led me to the appropriate treatment. Today, I am relieved and headache-free, able to return to a healthy, normal life. I am truly grateful to Dr. Roy and the entire team at Manipal Hospital, Mukundapur, for their care and support. I continue to be on regular follow-up and medication, and I am doing well.”