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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 22:1239-1250 (8 2001)
© 2001 American Society of Neuroradiology

ARTICLE

Cervical MR Imaging in Postural Headache: MR Signs and Pathophysiological Implications

Indra Yousry^a, Stefanie Förderreuther^a, Bernhard Moriggl^a, Markus Holtmannspötter^a, Thomas P. Naidich^a, Andreas Straube^a and Tarek A. Yousry^a

^a From the Departments of Neuroradiology (I.Y., M.H., T.A.Y.) and Neurology (S.F., A.S.), Klinikum Grosshadern, Ludwig-Maximilians Universität, Munich, Germany; the Department of Anatomy, Ludwig-Maximilians Universität, Munich, Germany (B.M.); and the Department of Neuroradiology, Mount Sinai Hospital, New York (T.P.N.).

BACKGROUND AND PURPOSE: Postural headache most often occurs after lumbar puncture as post–lumbar puncture headache (PLPH) or, rarely, spontaneously as spontaneous intracranial hypotension headache (SIHH). In this prospective study, we used spinal MR imaging to determine the findings that would assist in the diagnosis of PLPH and SIHH and that would further our pathophysiological understanding of postural headache.

METHODS: The study group consisted of 15 healthy volunteers and 20 patients with postural headache: nine with SIHH and 11 with PLPH. The craniocervical junction and the cervical spine were studied using T2-weighted fast spin-echo and T1-weighted spin-echo sequences in the axial and sagittal planes. Follow-up studies were performed in 13 patients.

RESULTS: Dilatation of the anterior internal vertebral venous plexus was the most constant finding, present in 17 (85%) of 20 patients with postural headache. Spinal hygromas, whose location as subdural or epidural could not be exactly determined, were present in 14 patients (70%). A focal fluid collection was detected in the retrospinal region at the C1–C2 level in six patients with SIHH and in four patients with PLPH (50%). Tonsillar descent was detected in only one patient, and subtentorial hygroma in five patients. No abnormalities were found in the volunteers.

CONCLUSION: The MR signs of dilatation of the venous plexus, presence of spinal hygromas, and presence of retrospinal fluid collections can help to establish the diagnosis of intracranial hypotension. They are probably the result of decreased CSF volume, with the retrospinal fluid collections being a transudate from the venous plexus rather than frank extravasation. Resolution of these signs parallels resolution of the headache.

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