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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(03): 201-202
DOI: 10.1590/0004-282X20160183
IMAGES IN NEUROLOGY

Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid leaks

Hipotensão intracraniana secundária a fístula liquórica espinhal espontânea
Antonio Eustáquio Silva Junior
1   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brasil;
,
Patricia Pavan
2   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brasil.
,
Mariana Mari Oshima
1   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brasil;
,
Tânia Marchiori de Oliveira Cardoso
2   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brasil.
,
Fabiano Reis
1   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brasil;
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A 37-year-old woman presented with acute orthostatic hypotension and diffuse headache. Brain magnetic resonance imaging (MRI) revealed T2 hyperintense bilateral subdural effusions, diffuse pachymeningeal enhancement, slit ventricles and venous engorgement compatible with spontaneous intracranial hypotension. Single photon emission computed tomography with computed tomography (CT) and CT-cisternography showed a cerebrospinal fluid (CSF) leak at the left C1-C2 transition. Spontaneous intracranial hypotension is a rare cause of daily headache, which remains largely underdiagnosed[1],[2], and current evidence indicates that this condition is the result of a spontaneous CSF leak[1],[2],[3],[4]. This case illustrates the importance of CT-cisternography in the detection of CFS leak[1],[2],[3], allowing appropriate diagnosis and treatment.

Zoom Image
Figure 1 Coronal T1 post contrast MRI demonstrates pachymeningeal enhancement (arrows); (B) axial T2 weighted MRI demonstrates subdural effusions (arrows); (C) Sagittal T1-weighted post contrast demonstrates engorgement of the superior sagittal sinus (straight arrow) and sagging of the brain (flattening of the pons and obliteration of prepontine cistern, curved arrow).
Zoom Image
Figure 2 Sagittal and axial sections of CT-cisternography (A) axial and (B) sagittal show a C1-C2 left cerebrospinal fluid leak, with left fluid paravertebral collection (arrows).

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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Schievink WI. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia. 2008;28(12):1347-56. https://doi.org/10.1111/j.1468-2982.2008.01776.x
  • 2 Purdy RA. Understanding and managing spontaneous intracranial hypotension. Can J Neurol Sci. 2013;40(2):139-40. https://doi.org/10.1017/S0317167100013640
  • 3 Mokri B. Spontaneous intracranial hypotension. Continuum (Minneap Minn). 2015;21 4 Headache:1086-108.
  • 4 Hoffmann J, Goadsby PJ. Update on intracranial hypertension and hypotension. Curr Opin Neurol. 2013;26(3):240-7. https://doi.org/10.1097/WCO.0b013e328360eccc

Address for correspondence

Fabiano Reis
Faculdade de Ciências Médicas - UNICAMP, Departamento de Radiologia; Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz; 13083-887 Campinas SP
Brasil   

Publication History

Received: 20 January 2016

Accepted: 03 October 2016

Article published online:
05 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Schievink WI. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia. 2008;28(12):1347-56. https://doi.org/10.1111/j.1468-2982.2008.01776.x
  • 2 Purdy RA. Understanding and managing spontaneous intracranial hypotension. Can J Neurol Sci. 2013;40(2):139-40. https://doi.org/10.1017/S0317167100013640
  • 3 Mokri B. Spontaneous intracranial hypotension. Continuum (Minneap Minn). 2015;21 4 Headache:1086-108.
  • 4 Hoffmann J, Goadsby PJ. Update on intracranial hypertension and hypotension. Curr Opin Neurol. 2013;26(3):240-7. https://doi.org/10.1097/WCO.0b013e328360eccc

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Zoom Image
Figure 1 Coronal T1 post contrast MRI demonstrates pachymeningeal enhancement (arrows); (B) axial T2 weighted MRI demonstrates subdural effusions (arrows); (C) Sagittal T1-weighted post contrast demonstrates engorgement of the superior sagittal sinus (straight arrow) and sagging of the brain (flattening of the pons and obliteration of prepontine cistern, curved arrow).
Zoom Image
Figure 2 Sagittal and axial sections of CT-cisternography (A) axial and (B) sagittal show a C1-C2 left cerebrospinal fluid leak, with left fluid paravertebral collection (arrows).