Presentation
Orthostatic headaches.
Patient Data
For the age of the patient, the ventricles are diffusely small, and the sulci are particularly not prominent (diffuse brain swelling)
Moreover, there is slight herniation of the cerebellar tonsils through the foramen magnum (3 mm). The suprasellar cistern is almost erased. There is a downward deformity of the splenium (droopy penis sign).
After IV gadolinium administration, there is an intense & diffuse pachymeningeal enhancement.
The presentation is compatible with spontaneous intracranial hypotension. This patient also had a subdural collection at the right upper convexity.
The patient was treated with blood patch. Following treatment of this condition, the patient had no residual headaches. She underwent a repeat MRI.
The ventricular system now has a normal volume. The suprasellar cistern is more prominent. The cerebellar tonsils are in normal position. There is no pachymeningeal enhancement.
Case Discussion
The patient was treated with blood patch and the headaches completely resolved. This is a typical example of spontanous intracranial hypotension. Spontaneous intracranial hypotension most commonly results from CSF leaks in the cervical and thoracic spine, and leads to alterations in the equilibrium between the volumes of intracranial blood, CSF, and brain tissue (Monro - Kellie hypothesis). A decrease in CSF volume leads to compensatory dilatation of the vascular spaces, mostly venous side due to its higher compliance.
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