NEURORADIOLOGY: Vascular

Case Author: Megan K. Strother, MD, Vanderbilt University Medical Center

History

86-year-old man with intermittent dizziness, nausea, and vomiting.

Imaging Findings

Axial T1-weighted contrast-enhanced MR image (A) shows smooth dural enhancement. Axial T2-weighted MR image (B) shows a cystic extraaxial lesion in the anterior portion of the left middle cranial fossa and an indwelling ventriculostomy catheter.

• Intracranial hypotension
• Meningitis
• Metastasis to the meninges
• Neurosarcoid
• Postsurgical changes

Diagnosis

Intracranial hypotension

Teaching Points

Opening intracranial pressure (ICP) can be measured with lumbar puncture. Normal values for ICP are 5–15 mm Hg (6–20 cm H2O) in supine adults and up to 18 mm Hg (25 cm H2O) in children younger than 8 years. As many as 20% of patients with clinically diagnosed spontaneous intracranial hypotension have normal brain MRI findings.

Suggested Readings

Schievink WI, Maya MM, Louy C, Moser FG, Tourje J. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR 2008; 29:853–856
Yuh EL, Dillon WP. Intracranial hypotension and intracranial hypertension. Neuroimaging Clin N Am 2010; 20:597–617

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