{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:11:58Z","timestamp":1790399518900,"version":"4.1.0"},"reference-count":17,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,7]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2025-269404","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:31:03Z","timestamp":1774449063000},"page":"e269404","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Abducens nerve palsy as a false localising sign in spontaneous intracranial hypotension"],"prefix":"10.1136","volume":"19","author":[{"given":"Palaniraj","family":"Rama Raj","sequence":"first","affiliation":[{"name":"Department of Neurology, Northern Hospital, Epping, Victoria, Australia"},{"name":"Department of General Medicine, Shellharbour Hospital, Shellharbour, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Pho","sequence":"additional","affiliation":[{"name":"Department of Neurology, Northern Hospital, Epping, Victoria, 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