Correlations among brain and spinal MRI findings in spontaneous intracranial hypotension

Abstract

Objectives Several brain and spinal magnetic resonance imaging signs have been described in spontaneous intracranial hypotension. Their correlations are not fully studied. This study aimed to explore potential mechanisms underlying cerebral neuroimaging findings and to examine associations among spinal and brain magnetic resonance imaging signs. Methods We conducted a retrospective review of magnetic resonance myelography and brain magnetic resonance imaging records of patients with spontaneous intracranial hypotension. Categorical principal component analysis was employed to cluster brain neuroimaging findings. Spearman correlation was employed to analyze associations among different brain neuroimaging findings and between brain and spinal neuroimaging findings. Results In patients with spontaneous intracranial hypotension (n = 148), categorical principal component analysis of brain neuroimaging signs revealed two clusters: Cerebral venous dilation and brain descent. Among all brain magnetic resonance imaging signs examined, only midbrain-pons angle associated with anterior epidural cerebrospinal fluid collection length (surrogate spinal cerebrospinal fluid leak severity) (n = 148, Spearman’s ρ = −0.38, p < .001). Subgroup analyses showed that the association between midbrain-pons angle (within brain descent cluster) and spinal cerebrospinal fluid leak severity was presented in patients with convex margins of the transverse sinuses (n = 122, Spearman’s ρ = −0.43, p < .001), but not in patients without convex margins (n = 26, Spearman’s ρ = −0.19, p = .348). The association between severity of transverse sinus distension and spinal cerebrospinal fluid leak severity was only presented in patients without convex margins (n = 26, Spearman’s ρ = 0.52, p = .006). Conclusion This study indicates that there are two factors behind the brain neuroimaging findings in spontaneous intracranial hypotension: Cerebral venous dilation and brain descent. Certain brain neuroimaging signs correlate with spinal cerebrospinal fluid leakage severity, depending on different circumstances.

Persistence and regredience of intraspinal fluid collection determine symptom control in intracranial hypotension syndrome

“…Spinal MRI can demonstrate various secondary spinal manifestations of IHS like ISFCs, dilated veins, and dural enhancement [2]. Supratentorial changes, as, for example, subdural hygromas, that are usually included into follow-up examination to ascertain regression are increasingly complemented by spinal imaging as well [18]. Since repeated or chronic microbleeds in IHS cases with an associated ISFC can lead to complications like SS [23] with potentially irreversible neurological deficits, spinal imaging rightfully deserves our attention.…”

“…Hence, failure in leakage closure and ISFC resorption may lead to irreversible structural lesions of the central nervous system. The efficacy of the blood patches or surgery was often correlated to the reversal of cerebral abnormalities [15,16]; however, more recently spinal alterations have become the focus of attention as well [17,18]. The aim of the following study was to clarify the association of clinical disease activity with regard to persistence or regression of ISFC in chronic IHS and to study long-term sequels with regard to the occurrence of a cerebral hemosiderosis.…”

Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections

“…Recent investigations reported that several predictors are thought to be related to the disease severity and treatment outcomes, for instance, pontomesencephalic angle and the angle between the vein of Gallen and the straight sinus (Fig. C) . By combining the CT and MRI findings, clinicians could reach more sensitive differential diagnosis of SIH.…”

“…4C). 36,37 By combining the CT and MRI findings, clinicians could reach more sensitive differential diagnosis of SIH. Second, there might be a selection bias since only those patients who were admitted to our institution presenting with bilateral subdural fluid collections were enrolled.…”

Brain volume changes in spontaneous intracranial hypotension: Revisiting the Monro-Kellie doctrine

“…Brain tissue volume, however, is generally considered invariable, and therefore, compensation would occur through an increase of blood volume, specifically venous blood, since veins are more adjustable than arteries (1). Prior studies have reported deformities of certain brain structures in SIH patients (15,20,21), and therefore, whether total brain tissue volume is invariable remains unknown. The primary aim of the current study was to evaluate whether brain tissue volume is fixed or variable in SIH patients using automatic quantitative methods.…”