Demographics:
61 years old, Female
Indication:
Headache
Findings
- Marked diffuse smooth dural thickening and enhancement with corresponding FLAIR signal hyperintensity, extending into the bilateral internal auditory canals
- Upward convex appearance of the pituitary gland
- Drooping of the optic chiasm, which is draped across the superior margin of the pituitary gland
- Dilated appearance of both transverse sinuses with suggestion of convex inferior borders
- Mamillopontine distance measures 4 mm
- Pontomesencephalic angle measures 32 degrees
- Interpeduncular angle measures 35 degrees
- Inferior descent of both cerebellar tonsils into the foramen magnum
Diagnosis
Intracranial hypotension
Sample Report
Constellation of findings, including diffuse dural thickening and enhancement, upward convex appearance of the pituitary gland, "midbrain sag", and low-lying cerebellar tonsils, is highly suggestive of intracranial hypotension. Recommend correlation with CSF pressure measurement and consideration of MR imaging of the spine to assess for possible CSF leak.
Otherwise, no evidence of acute intracranial abnormality.
Discussion
References