MRI upon presentation
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There is an extensive extradural fluid collection separating the dura from the bony spinal canal (curtain sign).
The extradural fluid collection shows a T2 hyperintense signal compared to CSF (which shows a slightly lower signal due to flow/pulsation artifacts). The fluid collection shows a T1 hyperintense signal to CSF, probably due to proteinaceous content. The differential diagnosis of an epidural haemorrhage is excluded by a sagittal haemosensitive sequence which shows no blood products. We therefore suspect a spontaneous cerebrospinal fluid leak (CSF leak) with intracranial hypotension as a cause for the patients postural symptoms.
The cranial T1 C+ sequence demonstrates diffuse smooth enhancing pachymeningeal thickening as well as the venous distension sign (rounding of the dominant dural venous sinus in sagittal imaging) fortifying the diagnosis of intracranial hypotension.