Diagnostic Value of Spinal MR Imaging in Spontaneous Intracranial Hypotension Syndrome

Abstract

BACKGROUND AND PURPOSE:Spontaneous intracranial hypotension (SIH) presents with orthostatic headache, and the diagnosis is made on the basis of low CSF pressure and brain MR imaging findings characteristic of the disorder. However, a broad spectrum of symptoms and MR imaging findings of SIH is recognized, and some cases have no typical MR imaging abnormalities. SIH is believed to be caused by CSF leakage from the spinal dural sac, whereas the usefulness of MR imaging of the spine remains unclear. Our aim was to elucidate the diagnostic value of brain and spinal MR imaging

When Should I Do Dynamic CT Myelography? Predicting Fast Spinal CSF Leaks in Patients with Spontaneous Intracranial Hypotension

“…1,4,11,12 However, to our knowledge, the ability of spinal MR imaging to predict fast CSF leaks has not been previously described.…”

CT-guided percutaneous translaminar approach for blood patching: case report and technical note

“…This phenomenon is caused by vasodilation and by traction of pain-sensitive structures due to downward displacement of the brain [14]. Distortions of the nerve trunks may cause dysfunction of the optic and VIth cranial nerves presented clinically by diplopia and visual field abnormalities, respectively, and reported to be improved after appropriate management [16]. Other symptoms, such as, vestibular and auditory symptoms due to variations in intra labyrinthine pressure [4], partial pituitary insufficiency due to traction of the pituitary stalk [12], cortical venous thrombosis due to the decreased venous blood flow velocity [15] and paroxysmal ataxia of gait [4] have been reported.…”

Pseudoarachnoiditis In Spontaneous Intracranial Hypotension

“…Brain MRI scans are normal in up to 20% of patients with SIH (5). In the absence of brain MRI abnormalities, spinal MRI is recommended to confirm the SIH diagnosis in patients (2).…”

“…Decreased intrathecal CSF leads to collapse of the spinal subarachnoid space and results in the enlargement of the epidural space; this phenomenon is associated with the enlargement of epidural veins and even accumulation of epidural CSF in the spinal canal (2). In addition to the Monro-Kellie hypothesis, a unique phenomenon ruling the spinal presentations of SIH is leakage of CSF into the epidural space (6).…”

“…Spinal MR imaging in SIH usually reveals a collapsed dural sac, extradural fluid collections, spinal meningeal enhancement, and dilatation of the epidural venous plexus, meningeal diverticula, and the presence of retrospinal fluid collections at C1-C2 (2, 7). The collapsed dural sac has a characteristic hexagon-like contour, which has been described as a "festooned appearance" (2).…”