{
  "abstract": "Spontaneous intracranial hypotension (SIH) with the formation of a spinal longitudinal epidural collection (SLEC) is an important treatable cause of headache. Left untreated, neurological sequelae can include cranial neuropathy, superficial siderosis and brain-sagging dementia. We describe a male in his late 40s presenting with orthostatic low-pressure headache and binocular horizontal diplopia due to an isolated left abducens nerve palsy, a recognised false localising sign. Imaging revealed intracranial hypotension associated with a SLEC, attributed to a cervical osteophyte associated dural tear. An empirical lumbar epidural blood patching led to rapid clinical improvement and radiological resolution of the SLEC on follow-up imaging. This case highlights that abducens nerve palsy, traditionally considered a false localising sign of raised intracranial pressure, can occur in low-pressure states. Spinal imaging is crucial for identifying SLEC and guiding management, enabling prompt treatment to prevent severe neurological outcomes. We also review the causes, diagnosis and management of SIH.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Northern Hospital, Epping, Victoria, Australia",
        "Department of General Medicine, Shellharbour Hospital, Shellharbour, New South Wales, Australia"
      ],
      "name": "Palaniraj Rama Raj"
    },
    {
      "affiliations": [
        "Department of Neurology, Northern Hospital, Epping, Victoria, Australia"
      ],
      "name": "Helen Pho"
    },
    {
      "affiliations": [
        "Department of Neurology, Northern Hospital, Epping, Victoria, Australia"
      ],
      "name": "Paul Kopanidis"
    },
    {
      "affiliations": [
        "Department of Radiology, Northern Hospital, Epping, Victoria, Australia"
      ],
      "name": "Hong Kuan Kok"
    }
  ],
  "title": "Abducens nerve palsy as a false localising sign in spontaneous intracranial hypotension",
  "uid": "9d946714-5fba-5e1c-8a3c-938caf094c6e"
}