Discrepant time course of cranial and spinal subdural collections in a case of SIH treated by EBP

Abstract

The MR monitoring of a patient with acute spontaneous intracranial hypotension successfully treated by epidural blood patch revealed strikingly different time course of the initially concomitant cranial and spinal subdural fluid collections. This undescribed feature suggested different pathophysiological mechanisms for the disorder in the two locations and should be kept in mind when imaging patients with the condition.

CT-Guided Epidural Blood Patching of Directly Observed or Potential Leak Sites for the Targeted Treatment of Spontaneous Intracranial Hypotension

“…Although less common than extradural collections in our experience, subdural collections have been reported previously. 28,29 In our case, targeted blood patching in the epidural space adjacent to the site of the visualized leak resulted in resolution of the collection, presumably due to mass effect, which compressed the dura against the arachnoid, thereby preventing further leakage.…”

The spectrum of spinal MR findings in SIH

“…We read with interest the article "Discrepant time course of cranial and spinal subdural collections in a case of spontaneous intracranial hypotension (SIH) treated by EBP" [1] and make the following comments.…”

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

“…21 The thickness of the subdural effusion/hematomas had increased for 1 to 2 months after epidural blood patch, but DPME (or diffuse pachymeningeal hyperintensity on FLAIR imaging) had improved. Follow-up MR imaging showed the subdural effusion/hematomas had improved without intervention.…”