Spinal dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension

Report of three cases and review of the literature

N. Nicole MoayeriDepartments of Neurosurgery, Neurology, and Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts

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John W. HensonDepartments of Neurosurgery, Neurology, and Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts

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Pamela W. SchaeferDepartments of Neurosurgery, Neurology, and Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts

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Nicholas T. ZervasDepartments of Neurosurgery, Neurology, and Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts

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Page Range:
912–918
Volume/Issue:
Volume 88: Issue 5
DOI link:
https://doi.org/10.3171/jns.1998.88.5.0912
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✓ This report offers a description of typical changes seen on gadolinium-enhanced magnetic resonance (MR) imaging of the entire spine that indicate spontaneous intracranial hypotension (SIH). To the authors' knowledge, this is the first report of its kind. They describe three cases of SIH that were accompanied by dural enhancement throughout the neuraxis on imaging, with the evolution of associated subdural and epidural fluid collections in the spine. Recognition of this disorder is important to be able to distinguish it from an infectious or neoplastic process in which surgical intervention might be warranted. Evaluation using gadolinium-enhanced cranial and spinal MR imaging in patients with postural headaches and an 111In-labeled cerebrospinal fluid leak study are discussed. Treatment with an epidural blood patch is shown to be particularly effective, with resolution of the radiological and clinical findings.

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Contributor Notes

Address reprint requests to: N. Nicole Moayeri, M.D., Division of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115. email: nmoayeri@bics.bwh.harvard.edu.
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