Spontaneous Intracranial Hypotension: Brain and Spinal MRI Findings

Aim: Spontaneous intracranial hypotension is a rare syndrome, characterized by orthostatic headache associated with a low cerebrospinal fluid pressure. The aim of this study is to examine the brain and spinal magnetic resonance imaging (MRI) findings of spontaneous intracranial hypotension among the cases presenting in our clinic.Material and Methods: 5 cases ( 4 females and 1 male) diagnosed with spontaneous intracranial hypotension in our clinic between February 1 st, 2013 and June 30th, 2014 were included in this study. The presenting symptoms, findings brain MRI of all patients and also spinal MRI of one patient were recorded.Results: All patients presented with orthostatic headache. The other associated symptoms were vertigo, nausea and tinnitus. Gadolinium- enhanced cranial MRI disclosed enhancement of the pachymeninges, engorgement of venous structures, subdural hematome, pituitary hyperemia in all patients. Downward herniation of bilateral amigdala and parahippocampal gyrus was observed in one of our patients. In another patient spinal MRI showed extradural fluid collection and venous engorgement.Conclusion: Spontaneous intracranial hypotension should be suspected in cases with orthostatic headache complaint. MRI is the non- invasive gold- standard imaging method in recognizing the typical findings and validation of the diagnosis.