Neuroradiologic Findings of Intracranial Hypotension: Two Cases

Abstract

A 26-year-old female was admitted to hospital with orthostatic headache, blurred and double vision, nausea, vomiting, and numbness of the hands. A neurologic examination revealed left abducens nerve palsy and left peripheral facial palsy. Cranial magnetic resonance imaging (MRI) showed diffuse dural thickening and contrast enhancement and bilateral -right predominant-subdural hematoma ( Figure 1). Spinal MRI and MR myelography showed multiple dural clefts, cerebrospinal fluid (CSF) accumulation around the spinal roots, and a right paracentral perineural cyst at the level of L1-2 (Figure 2, 3). The patient did not respond to bed rest, hydration, and analgesic treatment, and was treated with blood patch.A 33-year-old female was admitted to hospital with orthostatic headache, vertigo, and double vision. She had a baby with spontaneous vaginal delivery without regional anesthesia 1 month ago. Neurologic examination showed left abducens palsy. Cerebral and spinal MRI showed diffuse dural thickening and contrast enhancement. No abnormality was shown to cause CSF leakage (Figure 4). The patient responded to bed rest, hydration, and analgesic treatment.Intracranial hypotension is an intracranial pressure disorder characterized by orthostatic headache that worsens with standing Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Özlem Kayım Yıldız MD,