Spontaneous intracranial hypotension: correlation of imaging findings with clinical features.
BACKGROUND
Spontaneous intracranial hypotension (SIH) is increasingly recognized as a clinically variable and likely underdiagnosed syndrome caused by non-traumatic CSF leaks. The aim of this study was to correlate the findings of imaging studies - magnetic resonance imaging (MRI), radionuclide cisternography - with clinical features and CSF pressure in SIH in order to improve the diagnostic yield and management in patients with SIH.


METHODS
Clinical case study of 10 consecutive cases of SIH, MRI, radio-isotope cisternography.


RESULTS
5 out of 10 patients had unusual clinical symptoms of SIH(2 subdural haematomas, 1 gait ataxia, 1 tinnitus, 1 haemodialysis-associated headache). In 7 patients pachymeningeal gadolinium enhancement was detected in MRI accompanied by a reduced CSF opening pressure. In contrast, the 3 patients with normal MRI also had a normal CSF pressure. Radio-isotope cisternography was abnormal in all patients tested. There was no correlation between the severity of clinical symptoms and MRI or radionuclide cisternography findings.


CONCLUSIONS
The spectrum of clinical symptoms and imaging findings in SIH is highly variable. There- fore the diagnosis of SIH is often delayed. Radio-isotope cisternography is an important additional diagnostic method to detect CSF leaks or pathological kinetics of radio-isotope movement particularly in cases with normal MRI findings.
Wiesemann
Elke
E
Department of Neurology, Medical School Hannover, Hannover, Germany.
Berding
Georg
G
Goetz
Friedrich
F
Windhagen
Anja
A
D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D015170:Cerebrospinal Fluid Pressure; D005260:Female; D005682:Gadolinium; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed
D005682:Gadolinium