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MRI changes in intracranial hypotension
S C Pannullo1, J B Reich, G Krol
1Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Abstract:
We report seven patients with the syndrome of intracranial hypotension who were referred to Memorial Sloan-Kettering, primarily because of suspicion of meningeal tumor or infection raised by the finding of meningeal enhancement on MRI. In three patients, symptoms occurred after lumbar puncture; in four, there was no clear precipitating event. Lumbar puncture after MRI in six patients revealed low CSF pressure (six patients) and pleocytosis or high protein, or both (four patients). Three patients had subdural effusions. Six patients had measurable descent of the brain on midsagittal images. Postural headache resolved in all seven patients, six of whom had follow-up MRIs. Meningeal enhancement resolved or diminished in all six. Subdural effusions resolved spontaneously in two and were evacuated (but were not under pressure) in one. Downward brain displacement improved or resolved in all patients. The clinical syndrome and MRI abnormalities generally resolve on their own. An extensive workup is not helpful and may be misleading. Patients should be treated symptomatically.
Insights
Intracranial hypotension, often mimicking serious conditions like tumors, typically resolves spontaneously. This study highlights that symptomatic treatment is key, as extensive workups are often unnecessary and misleading for this condition.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Intracranial hypotension presents with symptoms mimicking serious neurological conditions.
- Meningeal enhancement on MRI can be a misleading indicator, often prompting concern for tumors or infections.
Observation:
- Seven patients with intracranial hypotension were evaluated, with symptoms arising post-lumbar puncture in three.
- MRI revealed meningeal enhancement, low cerebrospinal fluid pressure, and downward brain displacement in most patients.
- Associated findings included subdural effusions and pleocytosis or elevated protein in cerebrospinal fluid.
Findings:
- All seven patients experienced resolution of postural headaches.
- Meningeal enhancement and downward brain displacement improved or resolved in most patients.
- Subdural effusions resolved spontaneously or with intervention.
Implications:
- The clinical syndrome and associated MRI findings of intracranial hypotension often resolve spontaneously.
- Extensive diagnostic workups for intracranial hypotension can be unhelpful and potentially misleading.
- Symptomatic management is the recommended approach for patients diagnosed with intracranial hypotension.