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Cervical MR imaging in postural headache: MR signs and pathophysiological implications
I Yousry1, S Förderreuther, B Moriggl
1Department of Neuroradiology, Klinikum Grosshadern, Ludwig-Maximilians Universität, Marchioninstrasse 15, D-81377 Munich, Germany.
AJNR. American Journal of Neuroradiology
|August 11, 2001
Summary
Spinal MR imaging reveals key signs of intracranial hypotension, including venous plexus dilatation and fluid collections, aiding diagnosis of postural headaches like post-lumbar puncture headache (PLPH) and spontaneous intracranial hypotension headache (SIHH). These findings help understand headache pathophysiology.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Postural headache commonly presents as post-lumbar puncture headache (PLPH) or spontaneous intracranial hypotension headache (SIHH).
- Accurate diagnosis and understanding of the pathophysiology of these conditions are crucial.
Purpose of the Study:
- To identify spinal MR imaging findings aiding the diagnosis of PLPH and SIHH.
- To enhance the pathophysiological understanding of postural headaches.
Main Methods:
- Prospective study involving 15 healthy volunteers and 20 patients with postural headache (9 SIHH, 11 PLPH).
- Craniocervical junction and cervical spine imaging using T2-weighted and T1-weighted spin-echo sequences.
- Follow-up imaging performed in 13 patients.
Main Results:
- Dilatation of the anterior internal vertebral venous plexus observed in 85% of patients.
- Spinal hygromas present in 70% of patients.
- Focal retrospinal fluid collections at C1-C2 level detected in 50% of patients with SIHH and PLPH.
Conclusions:
- MR signs like venous plexus dilatation, spinal hygromas, and retrospinal fluid collections aid in diagnosing intracranial hypotension.
- These findings are likely due to decreased cerebrospinal fluid (CSF) volume.
- Resolution of MR findings correlates with headache symptom resolution.