Spontaneous intracranial hypotension (SIH) is characterized by severe postural headache and low cerebrospinal fluid (CSF) pressure. Radionuclide cisternography (RC) is of some value in diagnosing CSF leakage causing SIH. However, the sensitivity of RC is too low to demonstrate the site of leakage. In these cases, the early appearance of the radioactivity in the urinary bladder has also been use...

A literature search found no clinical trials or guidelines addressing the management of spontaneous intracranial hypotension (SIH). Based on the available literature and expert opinion, we have developed recommendations for the diagnosis and management of SIH. For typical cases, we recommend brain magnetic resonance (MR) imaging with gadolinium to confirm the diagnosis, and conservative measure...

A 35-year-old man presented with fever, headache, and vomiting. Lumbar puncture showed low pressure (50 mm H2O), raised levels of protein (4.96 g/L) and white cell count (2,500; 85% polymorphs), and a glucose level of 1.61 mmol/L. MRI demonstrated diffuse leptomeningeal and pachymeningeal enhancement (figure, A), suggesting meningitis and intracranial hypotension due to spontaneous skull base C...

Fluorescein is modified to bear 18F so that it can act as both a positron emitter, and a fluorophore, allowing detection by positron emission tomography (PET), scintillation, and fluorescent imaging (FL). [18F]-2 is injected into the intrathecal space of rats and used to observe the cerebrospinal fluid (CSF) that bathes the brain and spine. Injury in three different applications is visualized w...

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or h...

X.-L. Tan, MD, PhD Q.-D. Yang, MD, MSc X.-J. Liu, MD B. Xiao, MD, PhD B.-S. Tang, MD A 39-year-old woman developed orthostatic headache. Cranial MRI indicated spontaneous intracranial hypotension (SIH) (figure, A). Spinal MRI suggested CSF leaks at C1–2, C2–3, and C5–6 levels (figure, B and C), but both radionuclide cisternography and CT myelography (immediate and 3-hour delayed scanning) showe...

A 56-year-old woman presented with severe orthostatic headache in association with nausea and vomiting. Lumbar puncture for the patient revealed significantly low cerebrospinal fluid pressure (CSF) and the clinical diagnosis of intracranial hypotension syndrome was made. An initial gadolinium-enhanced brain magnetic resonance imaging (MRI) disclosed diffuse meningeal enhancement as well as brai...

This paper reviews the clinical findings in the Hakim-Adams syndrome and distinguishes it from the more general term of normal pressure hydrocephalus. The radiographic tests to diagnose these entities are discussed in their historical context. Computed tomography has recently replaced the pneumoencephalogram for evaluating ventricular size and configuration and computed tomographic metrizamide ...

PURPOSE Spontaneous intracranial hypotension (SIH) is a relatively uncommon cause of headache, which usually presents as orthostatic cranial pain and is relieved by recumbency. The precise cause of spontaneous spinal cerebrospinal fluid leakage related SIH remains unknown. CASE REPORT We report the case of a 32-year-old man who presented with an orthostatic headache. Brain magnetic resonance ...

PURPOSE Our goal was to assess the role of MR cisternography in the examination of patients with suspected CSF rhinorrhea. METHODS MR cisternography was performed as a heavily T2-weighted fast spin-echo study with fat suppression and video reversal of the images in 37 patients over a 3-year interval. Twenty-four of the patients subsequently had exploratory surgery for fistula. Statistical ana...