Presentation
Dizziness, unsteadiness and headache in hypertensive a patient with cardiomyopathy. No context of alcoholism or malnutrition.
Patient Data
Age: 70 years
Gender: Male
From the case:
Intracranial hypotension
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The MRI sequences demonstrate:
- bilateral and extensive dural thickening with enhancement over the cerebral hemispheres and the posterior fossa with small size of the ventricular system and subarachnoid space (disproportional to the patient's age) in keeping with intracranial hypotension
- extensive white matter FLAIR and T2 hyperintensity is noted throughout both cerebral hemispheres and brainstem suggestive of chronic small vessel ischemia, particularly in a patient with hypertension. Pituitary prominent considering the age group. On GE sequence, no punctate areas of blooming artifact to suggest microhemorrhages of cerebral amyloid angiopathy or hypertension
- small areas of acute infarct with restricted diffusion in the left cerebellum, splenium, left centrum semiovale and frontal precentral region
Case Discussion
MRI features of intracranial hypotension with cerebral small vessel disease and acute small white matter infarcts in a hypertensive patient with cardiomyopathy.