Spontaneous intracranial hypotension: what radiologist should know.

Congress:

ECR 2020

Poster Number:

C-15125

Type:

Educational Exhibit

Keywords:

Not applicable, Education and training, Dilatation, Cerebrospinal fluid, History, Education, Complications, MR, CT-Angiography, CT, Management, Head and neck, Anatomy, Neuro

Authors:

A. N. Khan¹, K. S. Babar¹, U. S. Umer¹, R. A. Shah², M. Khan¹, S. Shabir³, Z. Malik⁴, A. Jang¹, M. Kumar⁵; ¹Peshawar/PK, ²Islamabad/PK, ³Rawalpindi/PK, ⁴Islamabad /PK, ⁵Karachi/PK

DOI:

10.26044/ecr2020/C-15125

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-15125

Fig. 1: Diagrammatic presentation of Monro-Kellie hypothesis in normal state and...

Fig. 5: MRI in patients with IH. Axial T2-weighted (A) and axial enhanced T1-weighted...

Fig. 6: MR examination in a patient with IH. Axial T2-weighted (A) and axial enhanced...

Fig. 7: MR examination in patients with IH. T1-weighted post-contrast images: coronal...

Learning objectives

The purpose of this educational exhibit is to: Review the definition and pathophysiology of Spontaneous intracranial hypotension. Highlight the radiological features which can help in diagnosis of Spontaneous intracranial hypotension. Signify the importance of early diagnosis and management of patients with Spontaneous intracranial hypotension, for the general radiologist.

Background

In this section, we will discuss the definition and pathophysiology of spontaneous intracranial hypotension (SIH) that will assist in understanding the radiological features. Definition: Spontaneous intracranial hypotension is defined as a rare neurological disease presenting with postural headaches related to decrease in cerebrospinal fluid pressure, commonly due to CSF leak [1]. Intracranial hypotension can occur spontaneously or secondary to other events like trauma and intervention, but here we will discuss spontaneous cause, which is most commonly due to dural abnormality leading to CSF leakage. Pathophysiology:...

Findings and procedure details

This section includes key radiological findings, use of intracranial angles and spine imaging for SIH. Key radiological findings in SIH: The key imaging findings are due to following mechanisms; 1. Compensatory increase in venous blood volume. 2. Sagging of brain especially midbrain. 1. Imaging findings related to Compensatory increase in venous blood volume: 1. Engorgement of the venous sinuses. Rounded appearance of the venous sinuses is demonstrated on MRI. On sagittal images the convex bulging of the border of the transverse sinus is termed as...

Conclusion

Spontaneous intracranial hypotension is a rare neurological disorder. It should be kept in mind in patients with headaches, because the eyes cannot see what the mind does not know. Timely diagnosis of SIH and CSF leak can lead proper management and effective treatment.

Personal information and conflict of interest

K. S. Babar; Peshawar/PK - nothing to disclose A. N. Khan; Peshawar/PK - nothing to disclose U. S. Umer; Peshawar/PK - nothing to disclose M. Khan; Peshawar/PK - nothing to disclose S. Shabir; Rawalpindi/PK - nothing to disclose R. A. Shah; Islamabad/PK - nothing to disclose Z. Malik; Islamabad/PK - nothing to disclose M. Kumar; Karachi/PK - nothing to disclose A. Jang; Peshawar/PK - nothing to disclose

References

Upadhyaya P, Ailani J. A Review of Spontaneous Intracranial Hypotension. Current Neurology and Neuroscience Reports. 2019;19(5). Rangel-Castillo L, Gopinath S, Robertson C. Management of Intracranial Hypertension. Neurologic Clinics. 2008;26(2):521-541. Michali-Stolarska M, Bladowska J, Stolarski M, Sąsiadek M. Diagnostic Imaging and Clinical Features of Intracranial Hypotension – Review of Literature. Polish Journal of Radiology. 2017;82:842-849. Shah L, McLean L, Heilbrun M, Salzman K. Intracranial Hypotension: Improved MRI Detection With Diagnostic Intracranial Angles. American Journal of Roentgenology. 2013;200(2):400-407. Farb R, Nicholson P, Peng P, Massicotte E, Lay...