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Neuroimaging features of spontaneous intracranial hypotension

L Spelle1, A Boulin, C Tainturier

  • 1Service de Neuroradiologie Interventionelle et Fonctionelle, Fondation A. de Rothschild, Paris, France. lspelle@fo-rothschild.fr

Neuroradiology
|September 8, 2001
PubMed

Insights

Spontaneous intracranial hypotension (SIH) causes postural headaches. Radionuclide cisternography identified cerebrospinal fluid (CSF) leaks, and treatment with epidural blood patches resolved symptoms in four adults.

Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Postural headache is a primary symptom of spontaneous intracranial hypotension (SIH).
  • SIH is often caused by cerebrospinal fluid (CSF) leakage along the spinal axis.
  • Characteristic imaging findings include meningeal enhancement and brain sagging.

Purpose of the Study:

  • To evaluate the diagnostic utility of cranial MRI and radionuclide cisternography in SIH.
  • To assess the effectiveness of epidural blood patch treatment for CSF leaks in SIH.

Main Methods:

  • Review of cranial MRI and radionuclide cisternograms in four adult patients with SIH.
  • Clinical and radiological follow-up post-treatment.
  • Treatment involved epidural blood injection at the site of CSF leak.

Main Results:

  • MRI revealed diffuse meningeal enhancement, subdural fluid collections, and brain sagging.
  • Radionuclide cisternography identified CSF leakage.
  • All patients experienced symptom resolution after epidural blood patch treatment.
  • Follow-up MRI showed decreased but persistent meningeal enhancement.

Conclusions:

  • Radionuclide cisternography is effective in locating CSF leaks in SIH patients.
  • Epidural blood patching is a successful treatment for SIH.
  • Persistent meningeal enhancement may be observed even after symptom resolution.

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