IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Intracranial hypotension

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Postural headaches with vertigo. No history of trauma, surgery or lumbar puncture.

Patient Data

Age: 45years
Gender: Female
mri

The MRI sequences demonstrate:

  • bilateral small subdural effusions
  • extensive pachymeningeal thickening with enhancement over the cerebral hemispheres and the posterior fossa
  • prominent venous sinuses in the posterior fossa, with convex inferior margin of the right transverse sinus "venous distension sign" well-visualized on post-contrast sagittal sequence
  • small size of the ventricular system and subarachnoid cisterns
  •  pituitary hyperemia
  • sagging brainstem
  • quantitative signs
    • mamillopontine distance = 4 mm
    • pontomesencephalic angle = 23°
    • interpeduncular angle = 25° 

small non-specific FLAIR and T2 hyperintensities of the white matter.

Case Discussion

The MRI features are most consistent with spontaneous intracranial hypotension

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.