Learning objectives
Intracranial hypotension syndrome (IHS) is a syndrome with a variable aetiology and clinical presentation that is,
in most cases,
caused by leakage of cerebrospinal fluid (CSF) through the thecal sac.
Orthostatic headache associated to the typical magnetic resonance imaging (MRI) findings,
secondary to depletion of CSF,
is the key to a correct diagnosis.
Show the spectrum of imaging findings associated with intracranial hypotension syndrome.
Differential diagnosis with other pathologies similar findings.
Background
1.
Introduction
The syndrome of ICH is a single pathophysiological entity of diverse origin.
Usually,
it is characterized by an orthostatic headache,
that is,
one that occurs or worsens with upright posture,
although patients with chronic headaches or even no headache have been described.
In addition to headache,
patients may experience nausea,
vomiting,
anorexia,
neck pain,
dizziness,
horizontal diplopia,
changes in hearing,
galactorrhea,
facial numbness or weakness,
or radicular symptoms involving the upper limb,
all of which are orthostatic in nature.
Making a diagnosis of...
Imaging findings OR Procedure details
MRI brain sequences:
Standar sequences:
1.
SCOUT3 plane GRE localisers
2.
PD +T2 AXIALTurbo spin echo (TSE) axials.5 mmthick with 50% gap
3.
FLAIR AXIAL5 mm slices0.9 mmresolutionFOV230 mm
4.
FLAIR/T2 CORONAL5 mmthick with 50% gap
5.
T1 SAGIAL- age below 12
6.
T2 SAGITAL-age above 12
7.
AXIAL PRECONTRAST T1 spin echo (SE)
Post-contrast
Axial post-contrast T1 spin echo (SE)
Coronal post-contrast T1 spin echo (SE)
Optional Sequences
T1 Coronal low-susceptibilty
MP-RAGE isotropic T1-3D
Gradient axial
Diffusion
MRI spine sequences:
Standar sequences:
Sag T1...
Conclusion
Spontaneous Intracranial Hypotension is a diagnostic dilemma as the patient may or may not present with the classic signs of SIH.
Thus,
the patient's recent history leading up to the first episode of headache is essential.
Correlation of any other presenting symptoms coupled with imaging modalities such as MRI should be employed to arrive at the correct diagnosis.
Prompt management is necessary to prevent further complications.
Conservative management along with autologous blood patches is an efficacious method to reduce the hypotension and to restore the...
References
1.
Rando T,
Fishman R.
Spontaneous intracranial hypotension: report
of two cases and review of the literature.
Neurology 1992;42:
481–487
2.
Fishman R,
Dillon D.
Dural enhancement and cerebral displacement
secondary to intracranial hypotension.
Neurology 1993;43:
609–611
3.
Pannullo S,
Reich J,
Krol G,
Deck M,
Posner J.
MRI changes
associated with intracranial hypotension and meningeal enhancement
on MRI.
Neurology 1993;43:919–926
4.
Benzon H,
Nemickas R,
Molloy R,
Ahmad S,
Melen O,
Cohen B.
Lumbar and thoracic epidural blood injections for spontaneous
intracranial hypotension.
Anesthesiology...