Syndrome of Orthostatic Headaches and Diffuse Pachymeningeal Gadolinium Enhancement

Mokri, Bahram; Piepgras, David G.; Miller, Gary M.

doi:10.4065/72.5.400

Cited by 292 publications

(286 citation statements)

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“…Subdural collections, prominent cavernous sinus and increased pituitary gland height may also be seen [7]. The flattening of the pons, ventricles and basal cisterns, representing the downward displacement of the brain and brainstem, can be observed.…”

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confidence: 96%

Spontaneous intracranial hypotension with pituitary adenoma

et al. 2006

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IntroductionAcquired intracranial hypotension is more frequent than spontaneous ones and they are usually due to a lumbar puncture, spinal anaesthesia and neurosurgical operations. Spontaneous intracranial hypotension (SIH) was first described by Schaltenbrand in 1938 [1]. SIH is a rare phenomenon characterised by postural headache, neck pain, nausea/vomiting and findings of cranial neuropathies. Although it was already a well known clinical entity, the diagnostic value of imaging was better valued after magnetic resonance imaging (MRI) became widely available. The characteristic MRI findings are diffuse intracranial pachymeningeal thickening and enhancement, downward displacement of posterior fossa structures and pituitary gland enlargement. However, SIH associated with pituitary adenoma has not been previously reported. In this paper, a SIH case with pituitary adenoma and associated subsequent subdural haemorrhage is presented. Case reportA 41-year-old woman was presented to our hospital with a one-year history of severe headache, J Headache Pain (2006) 7:47-50 DOI 10.1007 Spontaneous intracranial hypotension with pituitary adenoma

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Spontaneous intracranial hypotension with pituitary adenoma

et al. 2006

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“…Magnetic resonance imaging (MRI) reveals diffuse meningeal thickening, gadolinium enhancement, and subdural fluid collections (hygromas and rarely haematomas), at times associated with diminished size of the subarachnoidal cisterns, with the descent of the cerebellar tonsils or with flattening of the optic chiasm [4][5][6][7][8][9]. In such cases, differential diagnosis with systemic diseases like rheumatoid arthritis, mucopolysaccaridosis, sarcoidosis and meningeal carcinomatosis must be performed [10][11][12].…”

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confidence: 99%

Headache in intracranial hypotension

Lia¹,

Bottacchi²,

Brusa³

et al. 2003

J Headache Pain

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We describe the headache characteristics of two patients with intracranial hypotension (IH) and correlate the magnetic resonance imaging (MRI) pattern to the clinical aspects of this type of headache. The first case was that of a patient with spontaneous IH, whereas the second patient had IH following rhinorrhoea. Cerebral computed tomography (CT) performed at presentation of symptoms was normal in both patients. Cerebral MRI in the first case showed meningeal contrast enhancement and an MRI pattern consistent with a subdural hygroma, while in the second case there was only a mild meningeal thickening. The symptoms improved spontaneously in both cases in about 2–3 months, confirming that invasive manoeuvres are not mandatory in these patients.

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“…In 1997, this syndrome was defined by a classical triad of postural headaches, low cerebral spinal fluid (CSF) pressure and imaging abnormalities 2 . More recent evidence has redefined this concept and our understanding of the pathological mechanism, as well as the variable clinical presentations and alternative treatment approaches in this condition.…”

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confidence: 99%

“…In many SIH cases, identification of the CSF leak may be a challenge 2,3 . Cerebral spinal fluid pressures less than 60 mm H 2 0 may not be present; in fact, normal CSF pressures have been reported in 18-46% of cases [4][5][6] .…”

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“…Nausea, vomiting, dizziness and posterior neck pain are all common. Neurological manifestations include visual symptoms such as diplopia, visual blurring, field defects, or photophobia 16 , hearing abnormalities including tinnitus, distortions and sensory neural hearing loss 15,16 , various cranial nerve palsies, and even peripheral manifestations of interscapular pain or radicular symptoms 2,5,12,14 . Unusual clinical manifestations have been described in case reports and include parkinsonism, gait abnormalities, cerebellar ataxia 17 , bipolar disorder 18 , encephalopathy, cognitive changes (including one case of frontotemporal dementia [FTD]) 19 , obtundation and coma 11,[20][21][22][23] .…”

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confidence: 99%

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