Intracranial Hypotension: The Nonspecific Nature of MRI Findings

Bruera, Osvaldo; Bonamico, Lucas; Giglio, Jorge Alberto; Sinay, Vladimiro; Leston, Jorge; Figuerola, María de Lourdes

doi:10.1111/j.1526-4610.2000.00154.x

Cited by 20 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many characteristic MR findings have been associated with IH regardless of its etiology. [1][2][3][4][5][6][7][8][9][10][11][12] On review of the MR imaging of patients presenting to our institution with IH, we have identified a highly reliable novel imaging sign for the diagnosis of IH. We have termed this sign the "venous distension sign" (VDS) and evaluated for it on routine nonenhanced sagittal T1-weighted imaging of the brain.…”

mentioning

confidence: 99%

The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the Brain

Farb¹,

Forghani²,

Lee³

et al. 2007

American Journal of Neuroradiology

141

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE:Patients with intracranial hypotension (IH) demonstrate intracranial venous enlargement with a characteristic change in contour of the transverse sinus seen on routine T1-weighted sagittal imaging. In IH, the inferior margin of the midportion of the dominant transverse sinus acquires a distended convex appearance; we have termed this the venous distension sign (VDS). This is distinct from the normal appearance of this segment, which usually has a slightly concave or straight lower margin. This sign is introduced, and its performance as a test for the presence of this disease is evaluated.

show abstract

mentioning

confidence: 99%

The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the Brain

Farb¹,

Forghani²,

Lee³

et al. 2007

American Journal of Neuroradiology

141

View full text Add to dashboard Cite

show abstract

“…1e, f). At a 1-year follow-up examination, she was free from PDPH symptoms.Imaging findings of severe PDPH may be similar to those of spontaneous intracranial hypotension, including PMGE, engorgement of the venous system, CSF accumulation, and subdural hematoma, as revealed by both cranial and spinal MRI [1][2][3]. In this case, despite resolution of the clinical symptoms, active CSF leakage was revealed by CT myelography and the opening pressure of CSF upon lumbar puncture was normal on day 15.…”

mentioning

confidence: 93%

Active cerebrospinal fluid leakage after resolution of postdural puncture headache

et al. 2011

View full text Add to dashboard Cite

The clinical course of a postdural puncture headache (PDPH) is generally benign and most cases resolve spontaneously within 1 week, or within 48 h after appropriate treatment. However, imaging findings from cases of PDPH have not been adequately reported. Herein, we report imaging findings and clinical symptoms during the recovery phase of PDPH after accidental dural puncture in a patient in whom active cerebrospinal fluid (CSF) leakage was revealed, despite resolution of PDPH symptoms.A 54-year-old woman had been treated with an epidural block for sciatic pain. However, she began to complain of headache, nausea, and vomiting from the day after that treatment (day 0). At the time of referral to our hospital on day 5, she was nearly bed-ridden because of an intolerable orthostatic headache and nausea. Results of a neurological examination were normal, except for the orthostatic headache, and previously existing painful numbness in the right L5 and S1 dermatome distributions. The patient did not report tinnitus or hearing disturbance. Cranial magnetic resonance imaging (MRI) on day 6 revealed pachymeningeal gadolinium enhancement (PMGE) and enlargement of the venous sinuses (Fig. 1a). We made a diagnosis of PDPH after accidental dural puncture. By day 8, the symptoms had improved with bed rest and hydration at 1500 ml/day. Lumbar MRI on day 8 revealed spondylolisthesis with a narrow canal at the L4-5 level. In addition, an abnormal hyperintensity back to the same level was noted by T2-weighted imaging (Fig. 1b, arrow). CSF accumulation associated with accidental dural puncture, meningeal diverticulum and juxta-facet cysts were considered for differential diagnosis. Computerized tomography (CT) myelography was performed for further evaluation on day 15 when the symptoms were nearly resolved. The opening pressure upon lumbar puncture in a lateral decubitus position at L2-3 was 160 mmH 2 O. Neither early nor delayed CT images of the entire spine after 20 ml intrathecal injection of contrast medium (Isovist Ò Inj. 240; Bayer Yakuhin, Limited, Osaka, Japan) revealed any cystic lesions. However, CSF leakage on the left side extending to the paraspinal muscle was found (Fig. 1c, d). We concluded that the abnormal findings obtained by lumbar MRI indicated CSF accumulation after accidental dural puncture. Cranial MRI performed 1 month later showed disappearance of PMGE and enlargement of the venous sinuses. Lumbar MRI 5 months after discharge confirmed the disappearance of abnormal hyperintensity (Fig. 1e, f). At a 1-year follow-up examination, she was free from PDPH symptoms.Imaging findings of severe PDPH may be similar to those of spontaneous intracranial hypotension, including PMGE, engorgement of the venous system, CSF accumulation, and subdural hematoma, as revealed by both cranial and spinal MRI [1][2][3]. In this case, despite resolution of the clinical symptoms, active CSF leakage was revealed by CT myelography and the opening pressure of CSF upon lumbar puncture was normal on day 15. Furthermore, lumbar MRI on day...

show abstract

“…Nonetheless, symptoms of ICH may be caused any time the duramater is traumatized, such as after diagnostic LP, myelography, spinal anesthesia, spinal injury, and spinal surgery (6,20,33), craniotomy or placement of a ventriculoperitoneal shunt (18). Systemic diseases such as dehydration, diabetic coma, uremia and, hyperpnea are the other medical causes of ICH (8).…”

Section: Introductionmentioning

confidence: 99%

A case of intracranial hypotension complicated with hydrocephalus

Özişik

Berker²,

Önal³

2009

Turkish Neurosurgery

View full text Add to dashboard Cite

AIM: Intracranial hypotension may have variable clinical presentation. The imaging characteristics of intracranial hypotension are especially well depicted on magnetic resonance imaging studies. Although the clinical and radiological manifestations of spontaneous intracranial hypotension are increasingly recognized in many reports, many other abnormalities in this disorder and complicating cases still exist. MATeRIAL and MeTHodS:A 16-year-old patient suffering from nausea, vomiting and blurred consciousness was admitted to the hospital. MRI showed diffuse pachymeningeal thickening resembling intracranial hypotension and ventricular enlargement like compensated hydrocephalus. The patient was investigated and treated using endoscopic third ventriculostomy. CoNCLUSIoN: The authors presented a case of intracranial hypotension complicated with hydrocephalus. Specific causes for intracranial hypotension as well as additional new treatment options will also be discussed. KeywoRdS: Intracranial hypotension, Triventricular hydrocephalus, Lumbar puncture, Herniation ÖZ AMAç: İntrakranial hipotansiyon farklı klinik bulgular verebilen bir antitedir. MRI bulguları literatürde ayrıntılı olarak tarif edilmekle birlikte, nöroşirürji pratiğinde her zaman akla gelmemektedir. Aynı bulguların farklı sinir sistemi hastalıklarında da görülebilmesi, vakaları komplike hale getirmektedir. yÖNTeM ve GeReç: 16 yaşında bayan hasta bulantı-kusma ve bilinç bulanıklığı nedeniyle hastanemize yatırıldı. MRI intrakranial hipotansiyonla uyumlu difüz pakimeningeal kalınlaşma ve kontrast tutulumu ve eşlik eden triventriküler genişleme gösterdi. Hasta ayrıntılı olarak incelendi ve endoskopik yolla 3. ventrikülostomi yapılarak tedavi edildi. SoNUç: Yazarlar, arrest hidrosefali ile komplike olan bir intrakranial hipotansiyon vakasını sunmuş ve tedavi yöntemi ile birlikte tartışmışlardır. Endoskopik 3. ventrikülostomi, bu vaka için tanı koydurucu ve emniyetli bir seçenek olmuştur.

show abstract

Intracranial Hypotension: The Nonspecific Nature of MRI Findings

Cited by 20 publications

References 16 publications

The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the Brain

The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the Brain

Active cerebrospinal fluid leakage after resolution of postdural puncture headache

A case of intracranial hypotension complicated with hydrocephalus

Contact Info

Product

Resources

About