Brain MRI features of postdural puncture headache

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.