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Brain MRI features of postdural puncture headache
Fernando J Sánchez García1, Jose Jornet Fayos2, Aida Pastor Del Campo2
1Hospital La Ribera, Alzira, Spain fernandojsanchezgarcia@gmail.com.
Background:
Postdural puncture headache (PDPH) is a relatively common acute complication that occurs following regional anesthesia and is among the clinical features of secondary intracranial hypotension syndrome (IHS).The aim of this study was to document the radiological findings specific to PDPH with brain MRI and to determine whether these findings differed from those described in the third edition of the International Headache Society's International Classification of Headache Disorders (ICHD-3).
Methods:
Thirty patients who were diagnosed with PDPH based on the ICHD-3 clinical criteria were enrolled in the study and signed the informed consent form approved by our hospital ethics committee. Their symptoms were recorded and they underwent brain MRI before and after the administration of a gadolinium-based contrast agent within 48-72 hours after the onset of their orthostatic headache.
Results:
All patients with PDPH presented with MRI features of pachymeningeal enhancement. The thickness of the pachymeningeal enhancement varied from 0.6 mm to 4.1 mm, with a mean of 1.6 mm+0.8.No cases of brain sagging were observed. 4 of the 30 patients presented with intracranial subdural fluid collections, 7 presented with pneumocephalus and 7 pituitary gland enlargement.
Conclusions:
The radiological characteristics of IHS and PDPH are most likely the result of compensatory mechanisms in response to decreased cerebrospinal fluid pressure. The acute nature of PDPH probably causes its radiological MRI characteristics to differ from those of IHS, given that no brain sagging could be demonstrated.
Insights
Postdural puncture headache (PDPH) shows specific MRI findings like pachymeningeal enhancement, differing from typical intracranial hypotension syndrome. These radiological features result from compensatory mechanisms due to low cerebrospinal fluid pressure.
Area of Science:
- Neurology
- Radiology
- Anesthesiology
Background:
- Postdural puncture headache (PDPH) is a common complication after regional anesthesia.
- PDPH is a clinical feature of secondary intracranial hypotension syndrome (IHS).
Purpose of the Study:
- Document radiological findings specific to PDPH using brain MRI.
- Compare PDPH MRI findings with the International Classification of Headache Disorders (ICHD-3) criteria.
Main Methods:
- Thirty patients diagnosed with PDPH based on ICHD-3 criteria were enrolled.
- Brain MRI was performed before and after contrast administration within 48-72 hours of headache onset.
Main Results:
- All PDPH patients exhibited MRI features of pachymeningeal enhancement (mean thickness 1.6 mm).
- No brain sagging was observed; however, 4 patients had subdural fluid collections, 7 had pneumocephalus, and 7 had pituitary gland enlargement.
Conclusions:
- Radiological characteristics of IHS and PDPH likely stem from compensatory mechanisms for reduced cerebrospinal fluid pressure.
- The acute nature of PDPH may lead to distinct MRI findings compared to IHS, evidenced by the absence of brain sagging.
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