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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:34-38, January 2005
© 2005 American Society of Neuroradiology

Case Report
SPINE

Intradural Spinal Vein Enlargement in Craniospinal Hypotension

M. Todd Burtis^a, John L. Ulmer^a, Glenn A. Miller^b, Alexandru C. Barboli^c, Scott A. Koss^a and W. Douglas Brown^a,b,c

^a Division of Neuroradiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
^b Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
^c Department of Neurology, Medical College of Wisconsin, Milwaukee, WI

Address reprint requests and correspondence to John L. Ulmer, MD, Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226

Summary: We present a case of craniospinal hypotension in a 45-year-old woman with an associated epidural pseudomeningocele extending the entire length of the spine. The epidural pseudomeningocele was caused by a CSF leak at the T8 level. In addition to typical low-pressure symptoms, the epidural pseudomeningocele caused atypical symptoms characterized by positional thoracic radiculopathy. Craniospinal hypotension was associated with massive cervical epidural venous engorgement, as well as enlargement of the posterior spinal cord vein, which was reminiscent of a dural arteriovenous fistula at CT myelography. Enlargement of the posterior spinal vein is explained by the Monro-Kellie hypothesis, and the spinal analog to enlarged cerebral veins known to be associated with intracranial hypotension.

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