Neurological picture
Magnetic resonance imaging findings before and after treatment of spontaneous intracranial hypotension
| The first 150 words of the full text of this article appear below. |
The syndrome of spontaneous intracranial hypotension is characterised by postural headache, low CSF pressure, and MRI findings of diffuse pachymeningeal gadolinium enhancement without a history of head or back trauma or lumbar puncture.1 We report on the MRI findings of a patient with spontaneous intracranial hypotension, before and after treatment.
A 44 year old woman presented with severe subacute headache, vomiting,
and diplopia. Previously she had experienced a period of severe
headache that lasted for some weeks and resolved spontaneously. Neurological examination showed a left sided abducens nerve palsy and
was otherwise normal. A T1 weighted spin echo MRI image of the brain
after gadolinium administration showed diffuse and homogeneous meningeal thickening and enhancement (fig 1 A). To rule out meningitis a lumbar puncture was performed. The CSF opening pressure was 0 cm
H2O and fluid was obtained after a Vasalva manoeuvre.
Analysis of CSF was normal, even after repeating the
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Headache (including migraine)
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Pain (neurology)
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