Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid leaks

Antonio Eustáquio Silva Junior; Patricia Pavan; Mariana Mari Oshima; Tânia Marchiori de Oliveira Cardoso; Fabiano Reis

doi:10.1590/0004-282X20160183

Arquivos de Neuro-Psiquiatria, Table of Contents

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

Authors

Antonio Eustáquio Silva Junior

¹Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brasil;
Patricia Pavan

²Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brasil.
Mariana Mari Oshima

¹Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brasil;
Tânia Marchiori de Oliveira Cardoso

²Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brasil.
Fabiano Reis

¹Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brasil;

Abstract

Full Text

PDF Download

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.

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).

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).

References

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

Figures

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).

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).