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Diagnostic Value of Spinal MR Imaging in Spontaneous Intracranial Hypotension Syndrome - AJNR News Digest
October 2013
Spine

Diagnostic Value of Spinal MR Imaging in Spontaneous Intracranial Hypotension Syndrome

Arata Watanabe

Arata Watanabe

When we did our research, the findings of brain MRI had already been accumulated. However, we believed that the findings of spinal MRI should be more direct. Spontaneous intracranial hypotension (SIH) is a disease caused by CSF leakage from the spinal dural sac. When diagnosing SIH, combining spinal and brain MRI is more precise than brain MRI alone, and some patients with SIH do not present with any abnormal findings at all on brain MRI.

Indeed, combining brain and spinal MRI helps in our clinical practice. Furthermore, we use brain and spinal MRI for evaluation of therapeutic results.

The precise site of the CSF leakage is still difficult to ascertain, however, and we hope to find a new tool to identify the CSF leakage point.

We have published several other manuscripts regarding SIH, shown below.

References

  1. Takeuchi N, Horikoshi T, Kinouchi H, et al. Diagnostic value of the optic nerve sheath subarachnoid space in patients with intracranial hypotension syndrome. J Neurosurg 2012;117:372–77. doi: 10.3171/2012.5.JNS1271
  2. Horikoshi T, Watanabe A, Uchida M, et al. Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatment. J Neurosurg 2010;113:940–46. doi: 10.3171/2009.10.JNS09806
  3. Watanabe A, Horikoshi T, Uchida M, et al. Decreased diameter of the optic nerve sheath associated with CSF hypovolemia. AJNR Am J Neuroradiol 2008;29:863–64. doi: 10.3174/ajnr.A1027

 

Read this article at AJNR.org . . .

Editor's Note

Small spinal fluid collections associated with intracranial hypotension are often very difficult to precisely define on the sagittal images alone. In particular, I have had difficulty looking at the sagittal T1 and T2 and trying to make the diagnosis. STIR in the sagittal plane makes the small linear epidural fluid collections more conspicuous to the eye, because the epidural fat signal is suppressed. Axial images, either FSE or GE, are really a necessity to accurately define the epidural fluid, the inward position of the dural margin, and the abnormal prominence of the exiting roots due to the dilated venous plexus.