Article Figures & Data
Figures
- FIG 1.
A 57-year-old man with a surgically proved right tegmen tympani CSF leak without brain MR imaging findings associated with SIH (Bern score = 0). A, Sagittal T1-weighted image shows normal suprasellar (dotted line), mamillopontine (broken line), and prepontine distances (solid line). B, Contrast-enhanced coronal T1-weighted image shows normal dura without thickening or enhancement. C, Sagittal image from an MRV shows a nondistended dominant transverse sinus (arrow).
- FIG 2.
Illustration of a patient with a spontaneous supratentorial skull base CSF leak in the middle cranial fossa (A) with preserved CSF flow at the foramen magnum (B). This is in contrast to a patient with a spinal CSF leak (C) that could include a ventral dural tear or CSF-venous fistula, and potential sump effect with craniocaudal CSF flow at the foramen magnum (D) that contributes to findings associated with SIH including brain sag and pituitary engorgement shown here.
Tables
Brain MRI Findings Points Diffuse dural enhancement/thickening 2 Suprasellar cistern ≤ 4 mm 2 Engorged venous sinus 2 Subdural fluid collection 1 Prepontine distance ≤ 5 mm 1 Mamillopontine distance ≤ 6.5 mm 1 Probability of Spinal CSF Leak Total Points Low ≤2 Intermediate 3–4 High ≥5 MRI Findings # Patients (%) n = 31 Dural enhancement 1 (3%) Small suprasellar distance (≤4 mm) 2 (7%) Engorged venous sinus 1 (3%) Subdural fluid collection 0 Small prepontine distance (≤5 mm) 10 (32%) Small mamillopontine distance (≤6.5 mm) 9 (29%) Mean Bern score (SD) 0.9 (1.1) Lowlying cerebellar tonsils 2 (7%)
