Intracranial hypotension

Case contributed by Mina Sameh Rizk
Diagnosis almost certain

Presentation

Headache and sixth nerve palsy

Patient Data

Age: 50 years
Gender: Male
mri

Bilateral subdural collections at cerebral convexities are noted.

On the post-contrast T1WI sequence, there is diffuse pachymeningeal enhancement.

On axial T2WI sequence, there is reduced fluid within optic nerve sheath bilaterally.

The pituitary gland is not enlarged but there is an obvious CSF reduction in the sella and suprasellar cistern.

Reduced mamillopontine distance at 3mm. Normally it should be more than 5mm.

Reduced pontomesencephalic angle at 28˚. Normally it should be more than 50˚.

Annotated image

Case Discussion

The features are suggestive of intracranial hypotension.

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