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AJNR - American Journal of Neuroradiology

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Intracranial Hypotension as a Cause of Radiculopathy from Cervical Epidural Venous Engorgement: Case Report

Sait Albayram^a, Bruce A. Wasserman^a, David M. Yousem^a and Robert Wityk^b

^a Departments of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD
^b Departments of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD

View larger version (166K): [in a new window]   FIG 1. Contrast-enhanced sagittal T1-weighted (500/9/2 [TR/TE/NEX]) MR image shows the extent of venous engorgement in the cervical epidural space (arrows).

View larger version (174K): [in a new window]   FIG 2. Contrast-enhanced axial T1-weighted (400/8/2) MR images at the level of the C2 vertebral body show intense bilateral enhancement (straight solid arrows) in the anterolateral cervical epidural space, consistent with the dilated epidural venous plexus. Note prominent flow void (curved arrow) in the enhancing right plexus and extension of dilated venous structures (open arrows) into the intervertebral foramina.

View larger version (122K): [in a new window]   FIG 3. MR venogram (coronal reconstruction of maximum intensity projection) demonstrates cervical epidural venous engorgement from the most superior portion of the cervical spine to the thoracic inlet bilaterally (arrows).

View larger version (116K): [in a new window]   FIG 4. Indium-111 DTPA cisternogram (anterior view) obtained approximately 4 hours after intrathecal injection shows extraarachnoid accumulation of the radionuclide (arrow) at the lumbar level. L indicates left.

View larger version (169K): [in a new window]   FIG 5. Axial gradient-echo T2-weighted (40/15/1, flip angle 5°) MR image at the C2-C3 level obtained 6 months after symptoms spontaneously resolved shows improvement in the epidural venous engorgement bilaterally (arrows).