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Review
. 2017 Dec 15:82:842-849.
doi: 10.12659/PJR.904433. eCollection 2017.

Diagnostic Imaging and Clinical Features of Intracranial Hypotension - Review of Literature

Marta Michali-Stolarska  1 , Joanna Bladowska  1 , Mateusz Stolarski  2 , Marek J Sąsiadek  1
Affiliations
Review

Diagnostic Imaging and Clinical Features of Intracranial Hypotension - Review of Literature

Marta Michali-Stolarska et al. Pol J Radiol. .

Abstract

Intracranial hypotension (IH) is an uncommon, benign, and usually self-limiting condition caused by low cerebrospinal fluid (CSF) pressure, usually due to CSF leakage. The dominant clinical finding is an orthostatic headache. Other common clinical features include fever, nausea, vomiting, and tinnitus. Magnetic resonance imaging (MRI) plays an important role in the diagnosis and follow-up of patients with IH. Specific MRI findings include intracranial pachymeningeal enhancement, sagging of the brain, pituitary enlargement, and subdural fluid collections. Intracranial hypotension can mimic other conditions such as aseptic meningitis or pituitary adenomas. Differential diagnosis is important, because misdiagnosis may lead to unnecessary procedures and prolonged morbidity.

Keywords: Cerebrospinal Fluid Pressure; Headache; Intracranial Hypotension; Magnetic Resonance Imaging; Meningitis, Aseptic; Pituitary Gland.

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Figures

Figure 1
Figure 1
MRI in patients with IH. Axial T2-weighted (A) and axial enhanced T1-weighted image (B). There is bilateral, hyperintense, subtle widening of subdural spaces (A) with a significant pachymeningeal enhancement after contrast administration (arrow).
Figure 2
Figure 2
Sagittal T2-weighted MR images: (A) Patient with IH – evident sagging of the brain is observed, when compared to (B) a patient with normal brain.
Figure 3
Figure 3
MR examination in patients with IH. T1-weighted post-contrast images: coronal (A) and sagittal images (B) demonstrate an enlargement of the pituitary gland (arrow) and a significant pachymeningeal enhancement.
Figure 4
Figure 4
MR examination in a patient with IH. Axial T2-weighted (A) and axial enhanced T1-weighted image (B). Images of the brain show bilateral, hyperintense, parietal, subdural fluid collections with associated pachymeningeal enhancement.
Figure 5
Figure 5
MR examination of the cervical spine in patients with IH. Sagittal (A) and (B) axial T2-weighted images of the spine demonstrate a hyperintense fluid collection (arrow) in the anterior epidural space at the cervical level.
Figure 6
Figure 6
Initial MR examination in patients with IH (A, C) and follow-up examination after 2 months of steroid therapy (B, D). Sagittal (A, B) and axial (C, D) T1-weighted images after contrast administration. Before treatment, there was an enlargement of the pituitary gland with associated pachymeningeal enhancement (A, C). After therapy, MR images (B, D) revealed regression of previous MR findings; the pituitary gland is normal in size, and the pachymeningeal enhancement had disappeared.
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