title: Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report.
abstract: Meningeal enhancement on magnetic resonance (MR) imaging is considered the hallmark radiological feature of intracranial hypotension. The authors report on a patient who exhibited progressively symptomatic intracranial hypotension due to a lumbar cerebrospinal fluid (CSF) leak, but in whom MR imaging demonstrated no pachymeningeal enhancement. This 24-year-old man presented with a 6-week history of progressive orthostatic headaches that were associated with photo- and phonophobia. Four weeks before the onset of the headaches, the patient had undergone a lumbar laminectomy. Brain MR images revealed subdural fluid collections and brain sagging; however, meningeal enhancement was not present. Myelography demonstrated a CSF leak at the site of the laminectomy. At surgery, a large dural tear was repaired. The patient recovered well from the surgery, with complete resolution of his headaches. The absence of meningeal enhancement on MR imaging does not exclude a diagnosis of symptomatic intracranial hypotension.
authors.affiliation: Neurosurgical Institute and Imaging Medical Group, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. schievinkw@cshs.org
authors.forename: W I
authors.initials: WI
authors.lastname: Schievink
authors.forename: J
authors.initials: J
authors.lastname: Tourje
mesh_terms: D000328:Adult; D004388:Dura Mater / Q000601:surgery; D005402:Fistula / Q000601:surgery; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000601:surgery; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000473:pathology*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation