Presentation
Postural headaches with vertigo. No history of trauma, surgery or lumbar puncture.
Patient Data
Age: 45years
Gender: Female
From the case:
Intracranial hypotension
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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