Iatrogenic intracranial hypotension - enlarged subdural spaces

Case contributed by Dr Ammar Haouimi

Presentation

Febrile convulsion, nystagmus, and generalized hypotonia. Had twice lumbar puncture 4 days ago.

Patient Data

Age: 4 months
Gender: Female

At the posterior cerebral fossa, there is a bilateral pericerebellar fluid collection of CSF signal on all sequences. At the supratentorial level, there is also a bilateral fluid collection of CSF signal on all sequences, displacing the cerebral parenchyma medially with pachymeningeal enhancement. Presence of superficial cortical veins, traversing these collections "cortical vein sign" well-visualized on coronal T2WI at both infra/supratentorial levels, indicating enlarged subarachnoid spaces and not subdural hygroma. Note collapsed ventricular system at the supratentorial level.

A high signal intensity on FLAIR, and T2WI of the frontoparietal white matter mainly on the right with leptomeningeal enhancement indicating most likely a meningoencephalitis.

Case Discussion

This case illustrates an enlargement of the subarachnoid spaces most likely due to iatrogenic intracranial hypotension following a lumbar puncture

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Case information

rID: 66773
Published: 14th Mar 2019
Last edited: 18th Mar 2019
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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