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We report seven patients with the syndrome of intracranial hypotension who were referred to Memorial Sloan-Kettering,primarily because of suspicion of meningeal tumor or infection raised by the findings of meningeal enhancement on MRI.In three patients,symptoms occurred after lumbar puncture;in four,there was no clear precipitating event.Lumbar puncture after MRI in six patients revealed low CSF pressure(six patients)and pleocytosis or high protein,or both(four patients).Three patients had subdural effusions.Six patients had measurable descent of the brain on midsagittal images.Postural headache resolved in all seven patients,six of whom had followup MRIs.Meningeal enhancement resolved or diminished in all six.Subdural effusions resolved spontaneously in two and were evacuated (but were not under pressure)in one.Downward brain displacement improved or resolved in all patients.The clinical syndrome and MRI abnormalities generally resolve on their own.An extensive workup is not helpful and may be misleading.Patients should be treated symptomatically. |
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CAT scan
CAT scan,abnormal
cerebrospinal fluid
cerebrospinal fluid,abnormal
cerebrospinal fluid,elevated protein of
cerebrospinal fluid,pressure low
cough
gadolinium
head injury
headache
headache,positional
headache,post traumatic
intracranial hypotension
lumbar puncture
lumbar puncture,complications of
meningeal enhancement
MRI
MRI,abnormal
MRI,contrast enhanced
myelogram
myelogram,complications of
nausea and vomiting
pleocytosis of cerebrospinal fluid
primary intracranial hypotension
spinal headache
subdural effusion
trauma
treatment of neurologic disorder
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