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Case Reports
. 2021 Feb;11(1):e22-e24.
doi: 10.1212/CPJ.0000000000000777.

Intracranial Hypotension With Mild Parkinsonism and Bulbar Dysfunction

Keith T Cochran  1 , Anton N Hasso  1 , Nicolas M Phielipp  1
Affiliations
Case Reports

Intracranial Hypotension With Mild Parkinsonism and Bulbar Dysfunction

Keith T Cochran et al. Neurol Clin Pract. 2021 Feb.
No abstract available

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Figures

Figure 1
Figure 1. Magnetic Resonance Images Before and After Surgical Repair
(A) Sagittal T1-W image showing crowding of structures around the suprasellar cistern with downward displacement of the optic chiasm above the dorsum sella (long white arrow), compression of the interpeduncular cistern (short white arrow), narrowing of the 4th ventricle (long dashed white arrow) and downward cerebellar tonsillar herniation (short dashed white arrow). (B) Axial FLAIR image showing the absent suprasellar cistern (white arrow) with marked crowding of the cisterns of the incisura and compression of the midbrain (dashed white arrows), which is likely the cause of cranial nerve deficits and parkinsonism. (C and D) Saggital T1-W (C) and axial FLAIR (D) images from MRI obtained on clinical worsening of the patient after her first surgical repair. Note the persistence of downward displacement of the chiasm (upper arrow, C), cerebellar tonsillar herniation (lower arrow, C) and elongation of the midbrain (dashed arrow, D). (E) Sagittal T1-W image after final repair of a suspected CSF leak. Note the recovery of anatomical definition of the structures around the sella, including the nearly normal position of the cerebellar tonsils (white arrow) and normalization of the morphology of the 4th ventricle (dashed white arrow). (F) Axial FLAIR image after the final repair showing visualization of the suprasellar cistern (white arrows) and decreased compression of the midbrain (dashed arrows). Midbrain anterior-posterior diameter also appreciably decreased compared with previous.
Figure 2
Figure 2. CT Myelogram Axial and Coronal Images
(A and B) Serial axial images showing intrathecal contrast surrounding the thoracic spinal cord. Note the subtle extravasations of contrast on the right side from the 8th and 9th nerve root sleeves (arrows). (C) Coronal view showing extradural contrast from the 8th nerve root sleeve (arrow).
See this image and copyright information in PMC

References

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