Abstract
Fluid-attenuated inversion recovery (FLAIR) MR imaging has advantages to detect meningeal lesions. FLAIR MR imaging was used to detect pachymeningeal thickening and thin bilateral subdural effusion/hematomas in patients with spontaneous intracranial hypotension (SIH). Eight patients were treated under clinical diagnoses of SIH. Chronologic MR imaging studies, including the FLAIR sequence, were retrospectively reviewed. Initial MR imaging showed diffuse pachymeningeal thickening as isointense in 6 cases, hypoisointense in 1 case, and isohyperintense in 1 case on the T1-weighted MR images, and hyperintense in all cases on both T2-weighted and FLAIR MR images. Dural (pachymeningeal) hyperintensity on FLAIR MR imaging had the highest contrast to CSF, and was observed as linear in all patients, usually located in the supratentorial convexity and also parallel to the falx, the dura of the posterior fossa convexity, and the tentorium, and improved after treatment. These characteristics of diffuse pachymeningeal hyperintensity on FLAIR MR imaging were similar to diffuse pachymeningeal enhancement (DPME) on T1-weighted imaging with gadolinium. Initial FLAIR imaging clearly showed subdural effusion/hematomas in 6 of 8 patients. The thickness of subdural effusion/hematomas sometimes increased transiently after successful treatment and resolution of clinical symptoms. Diffuse pachymeningeal hyperintensity on FLAIR MR imaging is a similar sign to DPME for the diagnosis of SIH but does not require injection of contrast medium. FLAIR is useful sequence for the detection of subdural effusion/hematomas in patients with SIH.
Highlights
AND PURPOSE: Fluid-attenuated inversion recovery (FLAIR) MR imaging has advantages to detect meningeal lesions
Diffuse pachymeningeal hyperintensity on FLAIR MR imaging is a similar sign to diffuse pachymeningeal enhancement (DPME) for the diagnosis of spontaneous intracranial hypotension (SIH) but does not require injection of contrast medium
Spontaneous intracranial hypotension (SIH) syndrome is characterized by low CSF pressure and positional headache caused by leakage of spinal CSF.[1,2]
Summary
Eight patients were treated under clinical diagnoses of SIH. We retrospectively reviewed the MR images and clinical records of 9 patients treated for clinical diagnoses of SIH at our institution from 2000 to 2006. Criteria to establish the diagnosis of SIH were similar to those reported previously for SIH and included the following: diffuse headache that worsens within 15 minutes after sitting or standing, evidence of low CSF pressure on MR imaging, and spontaneous resolution of headache or within several days after epidural blood patch.[1,3,16] The 6 patients with SIH were treated supportively (strict bed rest) for 2 weeks after admission, and 2 patients improved. The most recent 2 patients with SIH received epidural blood patch without strict bed rest. The cases of these patients were partially reported previously.[17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
