Intracranial Hypotension: Improved MRI Detection With Diagnostic Intracranial Angles

Shah, Lubdha M.; McLean, Logan A.; Heilbrun, Marta E.; Salzman, Karen L.

doi:10.2214/ajr.12.8611

Cited by 71 publications

(65 citation statements)

References 31 publications

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“…Descent of the brain results in several identifiable anatomic changes: effacement of the suprasellar cistern, downsloping of the third ventricular floor resulting in descent of the mammilary bodies, narrowing of the prepontine cistern, narrowing of the vertical distance between the mammillary bodies and the pons (the so-called mammillo-pontine distance), and descent of the cerebellar tonsils toward the foramen magnum (Fig. 27,30 This latter imaging finding may cause confusion because cerebellar tonsillar ectopia is also a feature of Chiari I malformation, and both SIH and Chiari I may cause headache. 27,30 This latter imaging finding may cause confusion because cerebellar tonsillar ectopia is also a feature of Chiari I malformation, and both SIH and Chiari I may cause headache.…”

Section: Summary Of Important Considerations In the Approach To Sihmentioning

confidence: 99%

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Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

2018

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Section: Summary Of Important Considerations In the Approach To Sihmentioning

confidence: 99%

“…3). 27,30 This latter imaging finding may cause confusion because cerebellar tonsillar ectopia is also a feature of Chiari I malformation, and both SIH and Chiari I may cause headache.…”

Section: Summary Of Important Considerations In the Approach To Sihmentioning

confidence: 99%

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

2018

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“…Dural thickening is also seen as a reactive change to tumor in the underlying bone; this must be distinguished from true neoplastic invasion. It may also be the result of intracranial hypotension, likely driven by compensatory interstitial edema of the meninges in response to decreased volume of the CSF space [7]. If no underlying disease process is identified, the condition is labeled idiopathic HP.…”

Section: Introductionmentioning

confidence: 99%

Hypertrophic pachymeningitis

Hahn

Fulbright

Baehring

2016

Journal of the Neurological Sciences

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Hypertrophic Pachymeningitis (HP) denotes inflammation and thickening of the dura mater that can be idiopathic or secondary to a wide variety of conditions. Clinically, HP can present as debilitating headaches and cranial nerve defects but in other cases may be completely asymptomatic. We aimed to determine the relative incidence of different etiologies of HP and compare their associated imaging findings. Additionally, we sought to compare the clinical features of the underlying syndromes. We retrospectively examined twenty-two consecutive cases of HP seen in a single practitioner neurology practice over a ten-year time period. The most common etiologies were idiopathic HP and neurosarcoidosis. No imaging features were completely specific to any etiology. Nonetheless, idiopathic HP typically demonstrated diffuse regular enhancement whereas neurosarcoidosis was more likely to display a nodular enhancement pattern. Headache and cranial neuropathies were the most common clinical presentation. HP symptoms were often responsive to steroids but complete responses were rare. HP is a diagnostic challenge without specific findings on minimally or non-invasive diagnostic studies. Biopsy is often required and serves as the basis for effective therapy.

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“…Although infrequent (the annual incidence is five per 100 000 patients), this diagnosis can be easily missed by a trainee or radiologist who is unfamiliar with the condition, which can delay treatment. Symptoms of SIH include nausea, vomiting, neck pain, visual and/ or hearing disturbances, or vertigo, likely resulting from the tension of the cranial nerve owing to brain sagging (11).…”

Section: Positional Headaches And/or Multiple Cranial Nerve Deficitsmentioning

confidence: 99%

Skull Base–related Lesions at Routine Head CT from the Emergency Department: Pearls, Pitfalls, and Lessons Learned

Bello¹,

Graves²,

Rohatgi³

et al. 2019

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Routine non-contrast material-enhanced head CT is one of the most frequently ordered studies in the emergency department. Skull base-related pathologic entities, often depicted on the first or last images of a routine head CT study, can be easily overlooked in the emergency setting if not incorporated in the interpreting radiologist's search pattern, as the findings can be incompletely imaged. Delayed diagnosis, misdiagnosis, or lack of recognition of skull base pathologic entities can negatively impact patient care. This article reviews and illustrates the essential skull base anatomy and common blind spots that are important to radiologists who interpret nonenhanced head CT images in the acute setting. The imaging characteristics of important "do not miss" lesions are emphasized and categorized by their cause and location within the skull base, and the potential differential diagnoses are discussed. An interpretation checklist to improve diagnostic accuracy is provided. © RSNA, 2019 • Abbreviations: ASB = anterior skull base, CCJ = craniocervical junction, CPA = cerebellopontine angle, CSB = central skull base, CSF = cerebrospinal fluid, IIH = idiopathic intracranial hypertension, MCF = middle cranial fossa, PCF = posterior cranial fossa, PNS = paranasal sinuses, PPF = pterygopalatine fossa, SIH = spontaneous intracranial hypotension, TMJ = temporomandibular joint

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Intracranial Hypotension: Improved MRI Detection With Diagnostic Intracranial Angles

Cited by 71 publications

References 31 publications

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

Hypertrophic pachymeningitis

Skull Base–related Lesions at Routine Head CT from the Emergency Department: Pearls, Pitfalls, and Lessons Learned

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