Intracranial hypotension due to lumbar puncture presenting as a pseudo-subarachnoid hemorrhage on imaging Submit Manuscript | http://medcraveonline.com Abstract Background: A radiological pseudo-subarachnoid hemorrhage (pseudo-SAH) is defined as an increased attenuation along the tentorium cerebelli and falx, the basal cisterns, the Sylvian fissures and the subarachnoid spaces resembling a subarachnoid hemorrhage (SAH) on brain computed tomography (CT) scan. Several causes of pseudo-SAH have been reported. We present a female patient with headache and intracranial hypotension due to lumbar puncture (LP) in which the CT scan showed similar features to a typical SAH. The adequate diagnosis and treatment of intracranial hypotension was delayed until CT angiography (CTA), digital subtraction angiography (DSA) and magnetic resonance images (MRI) were performed to rule out SAH and its potential cause.
Case presentation:We present a 29-year-old woman who suffered from a severe postlumbar puncture headache (PLPH). A non-contrast brain CT scan revealed blurred frontal and parietal right sulci, and increased attenuation of the ipsilateral Sylvian fissure. SAH was diagnosed but the results of CTA and DSA were negative. A brain MRI demonstrated right brain sagging. Intracranial hypotension due to LP presenting as a pseudo-SAH was finally diagnosed, and her headache subsided after conservative therapy.
Conclusion:In patients with PLPH, intracranial hypotension should be considered in the differential diagnosis between SAH and pseudo-SAH. Although these two entities can share some clinical and radiologic features; intracranial hypotension has some distinctive MRI and CT findings. Brain sagging, bilateral subdural effusions or hematoma and pachymeningeal enhancement on MRI may be valuable findings for distinguishing between intracranial hypotension and SAH. These findings should be recognized to avoid unnecessary invasive procedures, delays in the diagnosis and implementing an adequate treatment.Citation: Ródiz PAB, Argüelles CF, Diaz JD, et al. Intracranial hypotension due to lumbar puncture presenting as a pseudo-subarachnoid hemorrhage on imaging. Int J Radiol Radiat Ther. 2018;5(2):95-98.Intracranial hypotension due to lumbar puncture presenting as a pseudo-subarachnoid hemorrhage on imaging 96
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