Presentation
Recurrent headaches, worse on standing. No history of trauma or surgery.
Patient Data
Post contrast T1W images reveal smooth and diffuse pachymeningeal enhancement. The dural venous sinuses appear distended. The pituitary gland also appears prominent. There is sagging of the tentorium cerebelli and the splenium of the corpus callosum.
MRI of spine shows epidural CSF collection with partial collapse of the dorsal spinal dura. The epidural venous flow voids appear prominent, particularly posterior to the lumbar vertebral bodies.
Case Discussion
This case demonstrates characteristic MRI findings of intracranial hypotension in brain and spine. In absence of previous trauma or a surgical procedure, the diagnosis of spontaneous intracranial hypotension is suggested. Venous distension sign and pachymeningeal enhancement are well demonstrated in this case.
The exact location of CSF leak is yet to be determined in this case.
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