Spontaneous Intracranial Hypotension in Professional Dancers: A Case Report and Rehabilitation Strategy.

Abstract

Introduction: Spontaneous intracranial hypotension (SIH) is a condition caused by a cerebrospinal fluid (CSF) leak, leading to a drop in intracranial pressure. SIH typically results from a spontaneous dural tear, often linked to connective tissue disorders, minor trauma, or repetitive spinal stress. Among dancers, especially in professional ballet, the risk of SIH may be increased by repetitive spinal hyperextension and strenuous movements. Ballet movements, such as the cambré, place significant stress on the spine, potentially leading to CSF leaks. Recognizing the signs of SIH, which often presents with orthostatic headaches and lumbar pain, is critical for timely intervention and recovery, especially in athletes like dancers where functional recovery is paramount. Methods: We report the case of a professional female ballet dancer who presented with severe orthostatic headache and lumbar pain after a hyperextension injury during a ballet performance. Brain magnetic resonance imaging revealed pachymeningeal enhancement and a CSF fistula at the T11 level, confirming a diagnosis of SIH. Conservative treatment, including bed rest, high fluid intake, and caffeine failed to relieve symptoms. Multiple blind blood patches and a fluoroscopically targeted patch were also unsuccessful. Results: Definitive management was achieved via epidural patching with fibrin glue, which corrected the dural defect. A specialized physical therapy regimen focusing on spinal stabilization, core strengthening, and gradual reintroduction of dance-specific movements was essential for her recovery. This approach aimed to reduce the risk of recurrence and safely transition the patient back to dance. Conclusion: SIH can result from hyperextension injuries in dancers, underscoring the importance of early diagnosis and multidisciplinary management. While conservative measures may fail in some cases, surgical correction, followed by a targeted rehabilitation program, plays a crucial role in full functional recovery. A rehabilitation program tailored to the demands of professional dancing is essential to minimize long-term complications and support a safe return to performance.