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AJNR - American Journal of Neuroradiology

Published ahead of print on April 16, 2008
doi: 10.3174/ajnr.A1041

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Diffuse Pachymeningeal Hyperintensity and Subdural Effusion/Hematoma Detected by Fluid-Attenuated Inversion Recovery MR Imaging in Patients with Spontaneous Intracranial Hypotension

M. Tosaka^a, N. Sato^b, H. Fujimaki^a, Y. Tanaka^a, K. Kagoshima^a, A. Takahashi^a, N. Saito^a and Y. Yoshimoto^a

^a Department of Neurosurgery, Gunma University Graduate School of Medicine, Gunma, Japan
^b Departments of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Gunma, Japan

View larger version (100K): [in this window] [in a new window]   Fig 1. Patient 5. Initial axial, half cut, and magnified MR images of a 39-year-old man with spontaneous intracranial hypotension who presented with a 1-month history of orthostatic headache, nausea, vomiting, and diplopia. Supportive treatment resolved the symptoms. A, T1-weighted image showing diffusely thickened dura mater as isointense. Subdural lesions are unclear. B, T2-weighted image showing that bilateral subdural effusion/hematomas could not be discriminated from CSF. C, T1-weighted image with gadolinium clearly showing diffuse pachymeningeal enhancement. D, FLAIR image showing diffuse pachymeningeal hyperintensity (arrowheads) and very thin bilateral subdural effusion/hematomas in the frontal region (arrow).

View larger version (120K): [in this window] [in a new window]   Fig 2. Patient 4. Chronologic FLAIR and T1-weighted MR images of a 37-year-old woman with spontaneous intracranial hypotension. She had a 1-month history of orthostatic headache. Cervical epidural blood patch resolved the symptoms. A, Initial FLAIR image showing diffuse pachymeningeal hyperintensity at the falx, tentorium, and dura of the posterior fossa (arrowheads) and bilateral thick subdural effusion/hematomas (arrows). B, Second FLAIR image performed 1 month after effective blood patch showing disappearance of the diffuse pachymeningeal hyperintensity but thickening of the subdural effusion/hematomas (arrows). C, Follow-up FLAIR image showing remnant subdural effusion/hematomas (arrows). D, Initial T1-weighted image with gadolinium showing DPME at the falx, tentorium, and dura of the posterior fossa (arrowheads) and bilateral thick subdural effusion/hematomas (arrows). E, Second T1-weighted image taken 1 month after completely effective blood patch showing slight remnant of DPME and thickening of the subdural effusion/hematomas (arrows). F, Follow-up T1-weighted image showing remnant subdural effusion/hematomas (arrows).

View larger version (125K): [in this window] [in a new window]   Fig 3. Patient 8. Chronologic FLAIR and T1-weighted MR images of a 47-year-old woman with spontaneous intracranial hypotension. She had a 1-week history of orthostatic headache. Lumbar epidural blood patch resolved the symptoms. A, Initial FLAIR image showing diffuse pachymeningeal hyperintensity (arrowheads). B, Second FLAIR image taken 1 week after completely effective blood patch showing thickened diffuse pachymeningeal hyperintensity (arrowheads) and partial subdural effusion/hematomas (arrows). C, Follow-up FLAIR image showing disappearance of the diffuse pachymeningeal hyperintensity and subdural effusion/hematomas. D, Initial T1-weighted image with gadolinium showing DPME (arrowheads). E, Second T1-weighted image taken 1 week after effective blood patch showing disappearance of DPME (arrowheads) and partial subdural effusion/hematomas (arrows). F, Follow-up T1-weighted image showing disappearance of the DPME and subdural effusion/hematomas.