Quiz Form

Question Date: 23/10/2023

Question: Which of these neuroimaging statement s is true in spontaneous intracranial hypotension?

Options:

• Diffuse pachymeningeal enhancement is seen in all following gadolinium contrast MRI
• Obliteration of midbrain pons angle is associated wit poor response to epidural blood patch
• High cervical retrospinal CSF collection points to this region as the commonest site of leak
• MR myelogram can detect fast flow CSF leaks

Correct Answer: Obliteration of midbrain pons angle is associated wit poor response to epidural blood patch

Explaination: Neuroimaging signs of spontaneous intracranial hypotension may be venous related (pachymeningeal enhancement, distention of venous sinuses, pituitary hyperemia) or brainstem descent related (obliteration of midbrain pons angle, flattening of pons, cerebellar tonsillar descent, posterior fossa crowding) Pachymeningeal enhancement is due to epidural venous congestion and may be absent early or late in the illness. Closure of midbrain pons angle suggests poor response to first epidural blood patch. T2 weighted MR myelogram shows high cervical retrospinal CSF collection which is considered as a false localizing sign. Fast CSF leak from CSF into epidural vein is demonstrated by digital subtraction myelography under fluoroscopic guidance

Reference: Wang S. Spontaneous Intracranial Hypotension. Continuum 2021 27(3 Headache) 746-766