Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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June 13, 2011
Spontaneous Intracranial Hypotension
- Syndrome in which low CSF volume results in orthostatic headache
- Generally due to CSF leakage through a dural defect
- May be related to predisposing underlying structural weakness of the spinal meninges
- Key Imaging Features: related to Monro-Kellie hypothesis: loss of CSF from subarachnoid space → increase in total intracranial blood volume causing enlargement of dural venous sinuses, epidural vertebral venous plexus, and pituitary gland. Transudation of intravascular fluid into subdural space causes dural enhancement and subdural fluid collections. Mass effect from subdural collections and decreased surrounding CSF cause brain sagging.
- CT or MR myelography useful to find source of CSF leak
- Treatment: Epidural blood patch
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