This 44 y/o female presented with severe headache, worse on sitting and standing and progressive in severity over two weeks. There were no focal neurologic signs on physical exam, T - 98.6°F and WBC - 9000/cc³. MRI with gadolinium enhancement was performed. Selected images shown above demonstrate meningeal thickening and enhancement. Lumbar puncture was performed. Opening pressure was <10 mm H2O. The fluid was viscous and markedly xanthochromic, protein was 200 mg/cc. There was no bacterial, fungal or TB growth. A nuclear cisternogram failed to demonstrate a site of CSF leakage. Spontaneous intracranial hypotension was diagnosed. Symptoms gradually abated over the following 6-8 weeks.
  1. Khurana RK. Intracranial hypotension. Semin Neurol 1996 Mar;16(1):5-10 PMID:8879051
  2. Mokri B. Spontaneous intracranial hypotension. Curr Pain Headache Rep 2001 Jun;5(3):284-91 PMID:11309218
  3. Ly JN, DeSilva SJ, Brazier D. Spontaneous intracranial hypotension. Australas Radiol 1999 Nov;43(4):548-50 PMID:10901980
  4. Tsui EY, Ng SH, Cheung YK, Fong D, Yuen MK. Spontaneous intracranial hypotension with diffuse dural enhancement of the spinal canal and transient enlargement of the pituitary gland. Eur J Radiol 2001 Apr;38(1):59-63 PMID:11287167
  5. Huang C, Chuang Y, Lee C, Lee R, Lin T. Spontaneous spinal cerebrospinal fluid leak and intracranial hypotension. Clin Imaging 2000 Sep-Oct;24(5):270-2 PMID:11331153
  6. Inenaga C, Tanaka T, Sakai N, Nishizawa S. Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension. Case report. J Neurosurg 2001 Apr;94(4):642-5 PMID:11302668
  7. Horton JC, Fishman RA. Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak. Ophthalmology 1994 Feb;101(2):244-51 PMID:8115145
  8. Bruera OC, Bonamico L, Giglio JA, Sinay V, Leston JA, Figuerola ML. Intracranial hypotension: the nonspecific nature of MRI findings. Headache 2000 Nov-Dec;40(10):848-52 PMID:11135032
  9. Quinones Tapia D, Pardo J, Serrano JM, Anciones V, Lopez-Ibor L. Spontaneous intracranial hypotension: use of unenhanced MRI. Neuroradiology 2000 Jul;42(7):529-31 PMID:10952188
  10. Schievink WI, Tourje J. Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report. J Neurosurg 2000 Mar;92(3):475-7 PMID:10701538
  11. Apte RS, Bartek W, Mello A, Haq A. Spontaneous intracranial hypotension. Am J Ophthalmol 1999 Apr;127(4):482-5 PMID:10218716
  12. Christoforidis GA, Mehta BA, Landi JL, Czarnecki EJ, Piaskowski RA. Spontaneous intracranial hypotension: report of four cases and review of the literature. Neuroradiology 1998 Oct;40(10):636-43 PMID:9833892
  13. Ferrante E, Riva M, Gatti A, Brioschi AM, Guccione A, Colombo N, Vanini M, Veronese S. Intracranial hypotension syndrome: neuroimaging in five spontaneous cases and etiopathogenetic correlations. Clin Neurol Neurosurg 1998 Mar;100(1):33-9 PMID:9637202
  14. Ali SA, Cesani F, Zuckermann JA, Nusynowitz ML, Chaljub G. Spinal-cerebrospinal fluid leak demonstrated by radiopharmaceutical cisternography. Clin Nucl Med 1998 Mar;23(3):152-5 PMID:9509928
  15. Moayeri NN, Henson JW, Schaefer PW, Zervas NT. Spinal dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension. Report of three cases and review of the literature. J Neurosurg 1998 May;88(5):912-8 PMID:9576264

Use the Back or Backward button on your browser to return