Presentation
Headache and vomitus that was contributed to serious meningitis. Girl had a lumbar spinal tap.
Patient Data
Present features of intracranial hypotension:
- probably small subdural effusion bilaterally frontopolar and perimesencephalic on precontrast sequences (or could be just dural thickening)
- diffuse dural enhancement (there is no leptomeningeal enhancement that would indicate meningitis)
- rounding and engorgement of venous sinuses
- convex contour and hyperemia of hypophysis
- small forward angling of brainstem
- mild herniation of cerebellar tonsils through foramen magnum
Case Discussion
Clinical outcome
The girl had a worsening postural headache after spinal tap that slowly passed away in the following two weeks.
Pathology
Intracranial hypotension is caused by CSF reduction:
- CSF leak
- most are spontaneous
- probably spontaneous meningeal tears that occur with higher incidence in connective tissue disorders (Marfan, Ehler Danlos,...)
- idiopathic procedure like spinal tap, myelography, spinal surgery, spinal anesthesia or excessive CSF shunting
- trauma
- most are spontaneous
- medical causes probably because of smaller CSF production (rare)
- dehydration
- diabetic coma
- uremia
Headache is thought to arise because of loss of CSF cushion effect with traction on intracranial structures or/and in part to venous vasodilatation.
Treatment
Usually conservative treatment with rest, hydration, caffeine intake and acetaminophen, if severe steroids.
If conservative treatment fails, epidural blood patches of leakage is usually effective. Surgical ligature is usually not needed.
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