MRI Diagnostics of Intracranial hypotension Syndrome on the Example of Clinical Observation

Intracranial hypotension is a clinical and radiological syndrome, manifested by a decrease in the volume or pressure of the cerebrospinal fluid caused by various reasons, one of the main clinical manifestations of which are orthostatic headaches. The gold standard in the radiation diagnosis of this condition is magnetic resonance imaging (MRI). Increasing the awareness of radiologists about this pathology, its manifestations on MRI, will allow more often to diagnose this syndrome and choose the tactics of further treatment. This publication presents its own clinical observation — a patient with intracranial hypotension syndrome, on his example, MR and clinical manifestations are considered, and some data on the etiology and pathogenetic mechanisms of the described pathological process are also given.

Cranial cerebrospinal fluid leak and intracranial hypotension syndrome – a case report

Spontaneous intracranial hypotension is a rare clinical entity caused in most cases by a cerebrospinal fluid leak occurring at the level of the spinal cord. Cranial dural leaks have been previously reported as a cause of orthostatic headaches but, as opposed to spinal dural leaks, were not associated with other findings characteristic of spontaneous intracranial hypotension. We present the case of a male admitted for severe orthostatic headache. The patient had a history of intermittent postural headaches, dizziness, and symptoms consistent with post-nasal drip, which appeared several years after head trauma. Brain imaging showed signs consistent with intracranial hypotension: bilateral hygromas, subarachnoid hemorrhage, superficial siderosis, diffuse contrast enhancement of the pachymeninges, and superior sagittal sinus engorgement. No spinal leak could be identified by magnetic resonance imaging, and the patient had a rapid remission of symptoms with conservative management. Further work-up identified an old temporal bone fracture which created a route of egress between the posterior fossa and the mastoid cells. Otorhinolaryngology examination showed pulsatile bloody discharge and liquorrhea at the level of the left pharyngeal opening of the Eustachian tube. The orthostatic character of the headache, as well as the brain imaging findings, were consistent with intracranial hypotension syndrome caused by a cranial dural leak. Clinical signs and imaging findings consistent with the diagnosis of apparently “spontaneous” intracranial hypotension should prompt the search for a cranial dural leak if a spinal leak is not identified.

A look at the medical history of Prosper Meniere’s patient from modern perspectives

The review summarizes information on the stages of independent assessments of the cause of patient death, presented in 1861 by Prosper Menier. The possibility of the presence of a symptom complex unknown to the author, characteristic of intracranial hypotension syndrome, is emphasized. Attention is drawn to the symptomatic similarity of neurological and common ENT diseases different in etiopathogenesis. The rarity of the onset of reduced intracranial pressure syndrome is questioned. Risk factors for intracranial hypotension syndrome are mentioned. A hypothetical justification of the cause of death in Prosper Menier is proposed.