Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid leaks

Abstract

A 37-year-old woman presented with acute orthostatic hypotension and diffuse headache. Brain magnetic resonance imaging (MRI) revealed T2 hyperintense bilateral subdural effusions, diffuse pachymeningeal enhancement, slit ventricles and venous engorgement compatible with spontaneous intracranial hypotension. Single photon emission computed tomography with computed tomography (CT) and CT-cisternography showed a cerebrospinal fluid (CSF) leak at the left C1-C2 transition. Spontaneous intracranial hypotension is a rare cause of daily headache, which remains largely underdiagnosed 1,2 , and current evidence indicates that this condition is the result of a spontaneous CSF leak 1,2,3,4 . This case illustrates the importance of CT-cisternography in the detection of CFS leak 1,2,3 , allowing appropriate diagnosis and treatment.

Magnetic Resonance-Guided Diagnosis of Spontaneous Intracranial Hypotension in a Middle-Aged Woman

“…Also, there are no subdural effusions and no pachymeningeal enhancement in Chiari I. In addition, MRI may show pachymeningeal gadolinium enhancement and engorgement of the dural venous sinuses on T1weighted images in patients with SIH [16] (Figure 2). is is caused by enlargement of the dural arteries or dilatation of cortical and medullary veins and dural venous sinuses [17].…”

“…Additional MRI findings associated with SIH are subdural effusions, closure of the midbrain-pons angle, enlargement of the pituitary, flattening of the pons, and obliteration of the prepontine cistern [16,17] (Figure 1).…”