Spontaneous intracranial hypotension: use of unenhanced MRI

Abstract

We report a case of spontaneous intracranial hypotension diagnosed with unenhanced cranial MRI, showing laminar subdural fluid and engorgement of the hypophysis and perisellar sinuses. Cerebrospinal fluid pressure was low. MRI was normal after resolution of symptoms. Prior reports emphasise the enhancing pachymeninges seen in this syndrome. We maintain that, when subdural collections and perisellar engorgement are detected on unenhanced MRI in the proper clinical setting, contrast enhancement may not be necessary for the diagnosis.

Treatment Outcomes in Spontaneous Intracranial Hypotension: Do Epidural Blood Patches Stop the Leaks?

“…The strengths of this investigation, compared to prior case reports and series, 1–25 included a well‐matched population of males and females with SIH, a gold standard radiographic method of diagnosis by MRI and/or CSF leak level detection by RC in most (47 out of 55) cases, and complete follow‐up data on treatment outcomes. The weaknesses of this investigation included a nonrandomized, uncontrolled retrospective study design that lumped similar reported cases together in a meta‐analysis and a relatively small sample size ( n = 55 cases) of a rare disease.…”

“…In a prior investigation of a small group of primarily female patients with SIH, we concluded that SIH was more common in women than in men, that men were more likely to present with cranial nerve deficits than women, and that other treatments to restore brain position and CSF dynamics should be considered 3 . To further investigate the presenting comorbidities of SIH and the treatment outcomes of EBPs and other interventional techniques, we reviewed the management of 55 cases of SIH reported since 1996 in a well‐matched population of men and women with radiographic confirmation of SIH and complete follow‐up data 1–25 …”

Successful Treatment of Spontaneous Cerebrospinal Fluid Leak Headache With Fluoroscopically Guided Epidural Blood Patch: A Report of Four Cases

“…The false‐negative rate for radioisotope cisternography, however, is high [7,12]. MRI findings include diffuse symmetric smooth dural thickening and pachymeningeal gadolinium enhancement, not only at the cranial level, but also involving the cervical spinal dura [11,13–17]. The detection of meningeal diverticula is common in these patients and does not always correlate with the site of CSF leak.…”