Pseudoarachnoiditis in Spontaneous Intracranial Hypotension

Abstract

Spontaneous intracranial hypotension is an important cause of new daily persistent headaches in young and middle-aged individuals. The diagnosis is made based on low cerebrospinal fluid pressure with characteristic findings upon brain and spinal magnetic resonance imaging (MRI). We present the case of a 15-year-old boy with spontaneous intracranial hypotension. Although his brain MRI was normal, his lumbar spinal MRI showed clustering of the nerve roots characteristic of arachnoiditis. Radionuclide cisternography revealed an epidural leak, which was treated with an epidural blood patch. The patient reached a near-full recovery within 24 h, and the lumbar spinal MRI findings mimicking arachnoiditis disappeared.

Keywords

• Spontaneous intracranial hypotension, pseudoarachnoiditis, spinal MRI

Pseudoarachnoiditis in Spontaneous Intracranial Hypotension

Öz

Kaynakça

1. 1. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia 2008;28:1345-56. [CrossRef]
2. 2. Watanabe A, Horikoshi T, Uchida M, Koizumi H, Yagishita T, Kinouchi H. Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome.AJNR Am J Neuroradiol 2009;30:147-51.
3. 3. Schievink WI, Maya MM, Louy C, Moser FG, Tourje J. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol 2008;29:853-6. [CrossRef]
4. 4. Fishman RA, Dillon WP. Dural enhancement and cerebral displacement secondary to intracranial hypotension. Neurology 1993;43:609-11.
5. 5. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006;295:2286-96. [CrossRef]
6. 6. Chen CJ, Lee TH, Hsu HL, Tseng YC, Wong YC, Wang LJ. Spinal MR findings in spontaneous intracranial hypotension. Neuroradiology 2002;44:996-1003.
7. 7. Yousry I, Förderreuther S, Moriggl B, Holtmannspötter M, Naidich TP, Straube A et al. Cervical MR imaging in postural headache: MR signs and pathophysiological implications. AJNR Am J Neuroradiol 2001;22:1239-50.
8. 8. Ross JS, Masaryk TJ, Modic MT, Delamater R, Bohlman H, Wilbur G et al. MR imaging of lumbar arachnoiditis. AJR Am J Roentgenol 1987;149:1025-32.

9. 9. Delamarter RB, Ross JS, Masaryk TJ, Modic MT, Bohlman HH. Diagnosis of lumbar arachnoiditis by magnetic resonance imaging. Spine 1990;15:304-10. [CrossRef]