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Spontaneous Intracranial Hypotension in the Absence of Magnetic Resonance Imaging Abnormalities

  • Kerrie L. Schoffer (a1), Timothy J. Benstead (a1) and Ian Grant (a1)

Abstract

Background:

Spontaneous intracranial hypotension (SIH) is a neurologic syndrome of unknown etiology, characterized by features of low cerebral spinal fluid (CSF) pressure, postural headache and magnetic resonance imaging (MRI) abnormalities.

Methods:

Four symptomatic cases of SIH presented to our institution over a six-month period. Magnetic resonance imaging studies were performed in all four cases. Diagnostic lumbar puncture was done in all except one case.

Results:

All of the patients on whom lumbar punctures were performed demonstrated low CSF pressure and CSF protein elevation with negative cultures and cytology. Three out of the four patients exhibited MRI findings of diffuse spinal and intracranial pachymeningeal gadolinium enhancement and extradural or subdural fluid collections. One patient had no MRI abnormalities despite prominent postural headache and reduced CSF pressure at lumbar puncture. All patients recovered with intravenous fluids and conservative treatment.

Conclusion:

Magnetic resonance imaging abnormalities are found in most, but not all patients, with SIH. Cerebral spinal fluid abnormalities can be detected even in patients with normal MRI studies. It is important to recognize the variability of imaging results in this usually benign disorder.

RÉSUMÉ: Introduction:

L’hypotension intracrânienne spontanée (HIS) est un syndrome neurologique d’étiologie inconnue, caractérisé par des manifestations d’une pression basse du liquide cérébro-rachidien (LCR), de céphalée posturale et d’anomalies à l’imagerie par résonance magnétique (IRM).

Méthodes:

Quatre patients présentant des symptoms d’HIS ont été évalués dans notre institution sur une période de six mois. Des études d’IRM ont été effectuées dans les quatre cas et une ponction lombaire diagnostique a été faite chez trois d’entre eux.

Résultats:

Tous les patients qui ont subi une ponction lombaire avaient une pression du LCR qui était basse et une élévation des protéines avec culture et cytologie négatives. À l’IRM, trois des quatre patients avaient des signes diffus de rehaussement pachyméningé spinal et intracrânien au gadolinium, et des collections de liquide extraduraux ou sous-duraux. Un patient présentait une IRM normale malgré une céphalée posturale marquée et une pression basse du LCR à la ponction lombaire. Tous les patients ont récupéré avec une hydratation parentérale et un traitement conservateur.

Conclusions:

On trouve des anomalies à l’IRM chez la plupart des patients présentant une HIS. Des anomalies du LCR peuvent être présentes même chez les patients dont l’IRM est normale. Il est important de connaître la variabilité observée à l’imagerie dans ce désordre habituellement bénin.

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Spontaneous Intracranial Hypotension in the Absence of Magnetic Resonance Imaging Abnormalities

  • Kerrie L. Schoffer (a1), Timothy J. Benstead (a1) and Ian Grant (a1)

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