Presentation
Insidious onset of headache (especially when switching to standing position), and intermittent nausea and vomiting.
Patient Data
Age: 25 years
Gender: Female
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- tonsillar herniation around 6 mm
- decreased amount fluid within the optic nerve sheath
- decreased mamillopontine distance (about 1.4 mm)
- decreased pontomesencephalic angle (around 35 degrees)
- mildly enlarged pituitary gland with a superiorly convex roof
- prominence and rounding (instead of the normal triangular shape in cross-section) of the dural venous sinuses without evidence of thrombosis
- diffuse pachymeningeal thickening and contrast enhancement
- hypoplastic rostral superior sagittal sinus
From the case:
Intracranial hypotension
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Annotations for some of the above-mentioned findings; the images are arranged in the following order:
- decreased mamillopontine distance (about 1.4 mm).
- decreased pontomesencephalic angle (around 35 degrees).
- tonsillar herniation for around 6mm.
- pachymeningeal thickening and contrast enhancement.
- pachymeningeal thickening and contrast enhancement.
- pachymeningeal thickening and contrast enhancement.
- mildly enlarged pituitary gland with a superiorly convex roof (craniocaudal dimension).
- mildly enlarged pituitary gland (width).
- mildly enlarged pituitary gland (anteroposterior dimension).
- decreased fluid within the optic nerve sheath.
Case Discussion
The clinical features and the imaging appearances are those of intracranial hypotension.
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