Radionuclide Cisternography in Diagnosing Spontaneous Intracranial Hypotension

Received 2/28/2004; revised 4/1/2004; accepted 4/5/2004. For correspondence or reprints contact: Ruoh-Fang Yen, M.D., Department of Nuclear Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan. Tel: (886)2-23562480, Fax: (886)2-23957855, E-mail: [email protected] It has been postulated that spontaneous intracranial hypotension is caused by the rupture of spinal meningeal diverticuli or cysts that resulting in cerebrospinal spinal fluid leakage. We present a case of 31year-old man who suffered a 2-month history of worsening headache in the upright posture, which was ameliorated completely when recumbent. No clear precipitant could be identified. Brain MRI, revealing increased dural enhancement associated with subdural collections and mild tonsilar herniation, suggested a suspicion of intracranial hypotension. Radionuclide cisternography with Tc-DTPA confirmed the diagnosis by demonstrating multiple focal areas of increased tracer activity appeared along both sides of paraspinal area at mid thoracic level in the image at 15 min, early appearance of bladder, and lack of activity over cerebral hemispheres up to 24 h.