title: Spinal dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension. Report of three cases and review of the literature.
abstract: This report offers a description of typical changes seen on gadolinium-enhanced magnetic resonance (MR) imaging of the entire spine that indicate spontaneous intracranial hypotension (SIH). To the authors' knowledge, this is the first report of its kind. They describe three cases of SIH that were accompanied by dural enhancement throughout the neuraxis on imaging, with the evolution of associated subdural and epidural fluid collections in the spine. Recognition of this disorder is important to be able to distinguish it from an infectious or neoplastic process in which surgical intervention might be warranted. Evaluation using gadolinium-enhanced cranial and spinal MR imaging in patients with postural headaches and an (111)In-labeled cerebrospinal fluid leak study are discussed. Treatment with an epidural blood patch is shown to be particularly effective, with resolution of the radiological and clinical findings.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, USA. nmoayeri@bics.bwh.harvard.edu
authors.forename: N N
authors.initials: NN
authors.lastname: Moayeri
authors.forename: J W
authors.initials: JW
authors.lastname: Henson
authors.forename: P W
authors.initials: PW
authors.lastname: Schaefer
authors.forename: N T
authors.initials: NT
authors.lastname: Zervas
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis; D017217:Blood Patch, Epidural; D002555:Cerebrospinal Fluid; D003287:Contrast Media; D003937:Diagnosis, Differential; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology*; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology; D005069:Evaluation Studies as Topic; D005260:Female; D005682:Gadolinium; D006261:Headache / Q000175:diagnosis; D006801:Humans; D007089:Image Enhancement; D007205:Indium Radioisotopes; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D008279:Magnetic Resonance Imaging; D011187:Posture; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013120:Spinal Cord Neoplasms / Q000175:diagnosis; D013353:Subdural Effusion / Q000175:diagnosis / Q000000981:diagnostic imaging; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; D005682:Gadolinium