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

Report of three cases and review of the literature

View More View Less
  • 1 Departments of Neurosurgery, Neurology, and Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

✓ 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.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Baker CC: Headache due to spontaneous low spinal fluid pressure. Minn Med 66:325328, 1983 Baker CC: Headache due to spontaneous low spinal fluid pressure. Minn Med 66:325–328, 1983

    • Search Google Scholar
    • Export Citation
  • 2.

    Bell WE, , Joynt RJ, & Sahs AL: Low spinal fluid pressure syndromes. Neurology 10:512521, 1960 Bell WE, Joynt RJ, Sahs AL: Low spinal fluid pressure syndromes. Neurology 10:512–521, 1960

    • Search Google Scholar
    • Export Citation
  • 3.

    Borges LL, , Zervas NT, & Lehrich JR: Idiopathic spinal cord herniation: a treatable cause of the Brown-Sequard syndrome: case report. Neurosurgery 36:10281033, 1995 Borges LL, Zervas NT, Lehrich JR: Idiopathic spinal cord herniation: a treatable cause of the Brown-Sequard syndrome: case report. Neurosurgery 36:1028–1033, 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Capobianco DJ, & Kuczler FJ Jr: Case report: primary intracranial hypotension. Milit Med 155:6466, 1990 Capobianco DJ, Kuczler FJ Jr: Case report: primary intracranial hypotension. Milit Med 155:64–66, 1990

    • Search Google Scholar
    • Export Citation
  • 5.

    Davenport RJ, , Chataway SJS, & Warlow CP: Spontaneous intracranial hypotension from a CSF leak in a patient with Marfan's syndrome. J Neurol Neurosurg Psychiatry 59:213, 1995 (Abstract) Davenport RJ, Chataway SJS, Warlow CP: Spontaneous intracranial hypotension from a CSF leak in a patient with Marfan's syndrome. J Neurol Neurosurg Psychiatry 59:213, 1995 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 6.

    Fishman RA, & Dillon WP: Dural enhancement and cerebral displacement secondary to intracranial hypotension. Neurology 43:609611, 1993 Fishman RA, Dillon WP: Dural enhancement and cerebral displacement secondary to intracranial hypotension. Neurology 43:609–611, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Garcia-Albea E, , Cabrera F, & Tejeiro J: Delayed postexertional headache, intracranial hypotension and racket sports. J Neurol Neurosurg Psychiatry 55:975, 1992 (Letter) Garcia-Albea E, Cabrera F, Tejeiro J: Delayed postexertional headache, intracranial hypotension and racket sports. J Neurol Neurosurg Psychiatry 55:975, 1992 (Letter)

    • Search Google Scholar
    • Export Citation
  • 8.

    Gaukroger PB, & Brownridge P: Epidural blood patch in the treatment of spontaneous low CSF pressure headache. Pain 29:119122, 1987 Gaukroger PB, Brownridge P: Epidural blood patch in the treatment of spontaneous low CSF pressure headache. Pain 29:119–122, 1987

    • Search Google Scholar
    • Export Citation
  • 9.

    Gibson BE, , Wedel D, & Faust R, et al: Continuous epidural saline infusion for the treatment of low CSF pressure headache. Anesthesiology 68:789791, 1988 Gibson BE, Wedel D, Faust R, et al: Continuous epidural saline infusion for the treatment of low CSF pressure headache. Anesthesiology 68:789–791, 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Good DC, & Ghobrial M: Pathologic changes associated with intracranial hypotension and meningeal enhancement on MRI. Neurology 43:26982700, 1993 Good DC, Ghobrial M: Pathologic changes associated with intracranial hypotension and meningeal enhancement on MRI. Neurology 43:2698–2700, 1993

    • Search Google Scholar
    • Export Citation
  • 11.

    Gormley J: Treatment of postspinal headache. Anesthesiology 21:565566, 1960 Gormley J: Treatment of postspinal headache. Anesthesiology 21:565–566, 1960

    • Search Google Scholar
    • Export Citation
  • 12.

    Hochman MS, , Naidich TP, & Kobetz SA, et al: Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI. Neurology 42:16281630, 1992 Hochman MS, Naidich TP, Kobetz SA, et al: Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI. Neurology 42:1628–1630, 1992

    • Search Google Scholar
    • Export Citation
  • 13.

    Horton JC, & Fishman RA: Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak. Ophthalmology 101:244251, 1994 Horton JC, Fishman RA: Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak. Ophthalmology 101:244–251, 1994

    • Search Google Scholar
    • Export Citation
  • 14.

    Jacobs MB, & Wasserstein PH: Spontaneous intracranial hypotension. An uncommon and underrecognized cause of headache. West J Med 155:178180, 1991 Jacobs MB, Wasserstein PH: Spontaneous intracranial hypotension. An uncommon and underrecognized cause of headache. West J Med 155:178–180, 1991

    • Search Google Scholar
    • Export Citation
  • 15.

    Kelley WN, , Harris ED Jr, & Ruddy S, et al: Textbook of Rheumatology, ed 5. Philadelphia: WB Saunders, 1997 Kelley WN, Harris ED Jr, Ruddy S, et al: Textbook of Rheumatology, ed 5. Philadelphia: WB Saunders, 1997

    • Search Google Scholar
    • Export Citation
  • 16.

    Kumar R, , Taha J, & Greiner AL: Herniation of the spinal cord. Case report. J Neurosurg 82:131136, 1995 Kumar R, Taha J, Greiner AL: Herniation of the spinal cord. Case report. J Neurosurg 82:131–136, 1995

    • Search Google Scholar
    • Export Citation
  • 17.

    Labadie EL, , Antwerp JV, & Bamford CR: Abnormal lumbar isotope cisternography in an unusual case of spontaneous hypoliquorrheic headache. Neurology 26:135139, 1976 Labadie EL, Antwerp JV, Bamford CR: Abnormal lumbar isotope cisternography in an unusual case of spontaneous hypoliquorrheic headache. Neurology 26:135–139, 1976

    • Search Google Scholar
    • Export Citation
  • 18.

    Lasater GM: Primary intracranial hypotension. The low spinal fluid pressure syndrome. Headache 10:6366, 1970 Lasater GM: Primary intracranial hypotension. The low spinal fluid pressure syndrome. Headache 10:63–66, 1970

    • Search Google Scholar
    • Export Citation
  • 19.

    Lipman IJ: Primary intracranial hypotension. The syndrome of spontaneous low cerebrospinal fluid pressure with traction headache. Dis Nerv Syst 38:212213, 1977 Lipman IJ: Primary intracranial hypotension. The syndrome of spontaneous low cerebrospinal fluid pressure with traction headache. Dis Nerv Syst 38:212–213, 1977

    • Search Google Scholar
    • Export Citation
  • 20.

    Marcelis J, & Silberstein SD: Spontaneous low cerebrospinal fluid pressure headache. Headache 30:192196, 1990 Marcelis J, Silberstein SD: Spontaneous low cerebrospinal fluid pressure headache. Headache 30:192–196, 1990

    • Search Google Scholar
    • Export Citation
  • 21.

    Masuzawa H, , Nakayama H, & Shitara N, et al: Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome. J Neurosurg 55:983986, 1981 Masuzawa H, Nakayama H, Shitara N, et al: Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome. J Neurosurg 55:983–986, 1981

    • Search Google Scholar
    • Export Citation
  • 22.

    McCrum C, & Williams B: Spinal extradural arachnoid pouches. Report of two cases. J Neurosurg 57:849852, 1982 McCrum C, Williams B: Spinal extradural arachnoid pouches. Report of two cases. J Neurosurg 57:849–852, 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Mokri B, , Krueger BR, & Miller GM, et al: Meningeal gadolinium enhancement in low pressure headaches. Ann Neurol 30:294, 1991 (Abstract) Mokri B, Krueger BR, Miller GM, et al: Meningeal gadolinium enhancement in low pressure headaches. Ann Neurol 30:294, 1991 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 24.

    Mokri B, , Parisi JE, & Scheithauer BW, et al: Meningeal biopsy in intracranial hypotension: meningeal enhancement on MRI. Neurology 45:18011806, 1995 Mokri B, Parisi JE, Scheithauer BW, et al: Meningeal biopsy in intracranial hypotension: meningeal enhancement on MRI. Neurology 45:1801–1806, 1995

    • Search Google Scholar
    • Export Citation
  • 25.

    Molins A, , Alvárez J, & Sumalla J, et al: Cisternographic pattern of spontaneous liquoral hypotension. Cephalalgia 10:5965, 1990 Molins A, Alvárez J, Sumalla J, et al: Cisternographic pattern of spontaneous liquoral hypotension. Cephalalgia 10:59–65, 1990

    • Search Google Scholar
    • Export Citation
  • 26.

    Murros K, & Fogelholm R: Spontaneous intracranial hypotension with slit ventricles. J Neurol Neurosurg Psychiatry 46:11491151, 1983 Murros K, Fogelholm R: Spontaneous intracranial hypotension with slit ventricles. J Neurol Neurosurg Psychiatry 46:1149–1151, 1983

    • Search Google Scholar
    • Export Citation
  • 27.

    Nabors MW, , Pait TG, & Byrd EB, et al: Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68:366377, 1988 Nabors MW, Pait TG, Byrd EB, et al: Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68:366–377, 1988

    • Search Google Scholar
    • Export Citation
  • 28.

    Nosik WA: Intracranial hypotension secondary to lumbar nerve sleeve tear. JAMA 157:11101111, 1955 Nosik WA: Intracranial hypotension secondary to lumbar nerve sleeve tear. JAMA 157:1110–1111, 1955

    • Search Google Scholar
    • Export Citation
  • 29.

    Page F: Intracranial hypotension. Lancet 1:15, 1953 Page F: Intracranial hypotension. Lancet 1:1–5, 1953

  • 30.

    Pannullo SC, , Reich JB, & Krol G, et al: MRI changes in intracranial hypotension. Neurology 43:919926, 1993 Pannullo SC, Reich JB, Krol G, et al: MRI changes in intracranial hypotension. Neurology 43:919–926, 1993

    • Search Google Scholar
    • Export Citation
  • 31.

    Petersen RC, , Freeman DP, & Knox CA, et al: Successful treatment of spontaneous low cerebrospinal fluid pressure headache. Ann Neurol 22:148, 1987 (Abstract) Petersen RC, Freeman DP, Knox CA, et al: Successful treatment of spontaneous low cerebrospinal fluid pressure headache. Ann Neurol 22:148, 1987 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 32.

    Pyeritz RE, , Fishman EK, & Bernhardt BA: Dural ectasia is a common feature of the Marfan syndrome. Am J Hum Genet 43:726732, 1988 Pyeritz RE, Fishman EK, Bernhardt BA: Dural ectasia is a common feature of the Marfan syndrome. Am J Hum Genet 43:726–732, 1988

    • Search Google Scholar
    • Export Citation
  • 33.

    Rando TA, & Fishman RA: Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 42:481487, 1992 Rando TA, Fishman RA: Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 42:481–487, 1992

    • Search Google Scholar
    • Export Citation
  • 34.

    Rupp SM, & Wilson CM: Treatment of spontaneous cerebrospinal fluid leak with epidural blood patch. J Neurosurg 70:808810, 1989 Rupp SM, Wilson CM: Treatment of spontaneous cerebrospinal fluid leak with epidural blood patch. J Neurosurg 70:808–810, 1989

    • Search Google Scholar
    • Export Citation
  • 35.

    Sable SG, & Ramadan NM: Meningeal enhancement and low CSF pressure headache. An MRI study. Cephalalgia 11:275279, 1991 Sable SG, Ramadan NM: Meningeal enhancement and low CSF pressure headache. An MRI study. Cephalalgia 11:275–279, 1991

    • Search Google Scholar
    • Export Citation
  • 36.

    Schaltenbrand G: Die akute Aliquorrhoe. Verhand Dtsch Ges Inn Med 52:473481, 1940 Schaltenbrand G: Die akute Aliquorrhoe. Verhand Dtsch Ges Inn Med 52:473–481, 1940

    • Search Google Scholar
    • Export Citation
  • 37.

    Schaltenbrand G: Normal and pathological physiology of the cerebrospinal fluid circulation. Lancet 1:805808, 1953 Schaltenbrand G: Normal and pathological physiology of the cerebrospinal fluid circulation. Lancet 1:805–808, 1953

    • Search Google Scholar
    • Export Citation
  • 38.

    Schaltenbrand V: Neuere Anschauungen zur Pathophysiologie der Liquorzirkulation. Zbl Neurochir 3:290295, 1938 Schaltenbrand V: Neuere Anschauungen zur Pathophysiologie der Liquorzirkulation. Zbl Neurochir 3:290–295, 1938

    • Search Google Scholar
    • Export Citation
  • 39.

    Schievink WI, , Meyer FB, & Atkinson JLD, et al: Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84:598605, 1996 Schievink WI, Meyer FB, Atkinson JLD, et al: Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84:598–605, 1996

    • Search Google Scholar
    • Export Citation
  • 40.

    Sipe JC, , Zyroff J, & Waltz TA: Primary intracranial hypotension and bilateral isodense subdural hematomas. Neurology 31:334337, 1981 Sipe JC, Zyroff J, Waltz TA: Primary intracranial hypotension and bilateral isodense subdural hematomas. Neurology 31:334–337, 1981

    • Search Google Scholar
    • Export Citation
  • 41.

    Stern WE: Dural ectasia and the Marfan syndrome. J Neurosurg 69:221227, 1988 Stern WE: Dural ectasia and the Marfan syndrome. J Neurosurg 69:221–227, 1988

    • Search Google Scholar
    • Export Citation
  • 42.

    Szeinfeld M, , Ihmeidan IH, & Moser MM, et al: Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology 64:820822, 1986 Szeinfeld M, Ihmeidan IH, Moser MM, et al: Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology 64:820–822, 1986

    • Search Google Scholar
    • Export Citation
  • 43.

    Teng P, & Papatheodorou C: Primary cerebrospinal fluid hypotension. Bull LA Neurol Soc 33:121128, 1968 Teng P, Papatheodorou C: Primary cerebrospinal fluid hypotension. Bull LA Neurol Soc 33:121–128, 1968

    • Search Google Scholar
    • Export Citation
  • 44.

    Weber WE, , Heidendal GA, & de Krom MC: Primary intracranial hypotension and abnormal radionuclide cisternography. Report of a case and review of the literature. Clin Neurol Neurosurg 93:5560, 1991 Weber WE, Heidendal GA, de Krom MC: Primary intracranial hypotension and abnormal radionuclide cisternography. Report of a case and review of the literature. Clin Neurol Neurosurg 93:55–60, 1991

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2092 902 71
Full Text Views 395 87 0
PDF Downloads 237 49 1
EPUB Downloads 0 0 0