Intracranial hypotension in patient with chiasmatic / hypothalamic glioma
Presentation
Had surgery with VP shunting for brain tumor 3 months ago, presented with headaches.
Patient Data
There is a lobulated mass centered on the suprasellar region with extension to the anterior portion of the 3rd ventricle and interpeduncular cistern. It appears of low signal on T1, inhomogeneous high signal FLAIR and T2 with heterogeneous enhancement on postcontrast sequences. The optic chiasma is not visualized as a separate structure.
The intraventricular drain is seen in the right occipital horn with normal size and configuration of the lateral ventricles.
Diffuse and extensive pachymeningeal thickening and enhancement over both cerebral hemispheres as well as the cerebral posterior fossa, suggesting intracranial hypotension.
Case Discussion
This patient had surgery (open biopsy) through a frontal craniotomy for chiasmatic / hypothalamic glioma with ventriculoperitoneal shunting for his obstructive hydrocephalus at the same time. Now he developed an intracranial hypotension most likely due to an over drainage of the VP shunt.
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