Diffuse Pachymeningeal Hyperintensity and Subdural Effusion/Hematoma Detected by Fluid-Attenuated Inversion Recovery MR Imaging in Patients with Spontaneous Intracranial Hypotension

Abstract

BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery (FLAIR) MR imaging has advantages to detect meningeal lesions. FLAIR MR imaging was used to detect pachymeningeal thickening and thin bilateral subdural effusion/hematomas in patients with spontaneous intracranial hypotension (SIH).

Reversal in the Diameter of the Superior Ophthalmic Vein after an Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension

“…The clinical manifestation, typical MRI features, and treatment options in SIH have been well described in the literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In this article, we introduce the "reversal of the SOV" sign following the EBP procedure, which we believe may imply the reconstruction of intracranial pressure.…”

“…The advent of MRI has revolutionized the understanding of SIH. Typical MR imaging features include subdural collections, dural thickening and pachymeningeal enhancement, engorged venous structures, pituitary hyperemia, and sagging of the brain (1,12). The superior ophthalmic vein (SOV) drains into the cavernous sinus and is theoretically influenced by the alteration in intracranial pressure.…”

Spontaneous Intracranial Hypotension with Magnetic Resonance Localisation of Spinal Cerebrospinal Fluid Leak

“…1 The main presenting feature in those patients is headache, which is aggravated by sitting or standing, and relieved by lying down. [1][2][3] There might be associated symptoms including nausea, vomiting or neck stiffness, with other features suggestive of cranial nerve neuropathies including vertigo and photophobia. Arterial cerebral infarcts are rare but potentially life-threatening complications of SIH.…”

“…1 These collections show high signal intensity in FLAIR images which can be attributed to dural thickening. 1,3,5 The most important intracranial MRI finding is diffuse pachymeningeal enhancement in T1-weighted post-contrast images. 1,3,6 Differential diagnoses include meningitis, meningeal metastasis, chronic subdural haematoma, post-surgical dural thickening and dural sinus thrombosis.…”

The contribution of imaging in diagnosis, preoperative assessment, and follow-up of moyamoya disease

“…The following differential diagnoses have to be kept in mind for the "ivy sign": SAH, meningitis, brain tumor or meningeal carcinomatosis, subdural hematoma, CSF hypotension, and hyperbaric O 2 therapy. 50,81 According to the guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis, 17 angiography is not mandatory for the diagnosis of moyamoya disease, because MR imaging and MR angiography can show all the findings required for diagnosis. Nevertheless, these authors recommend diagnosis made with the aid of MR techniques alone only in childhood cases.…”