2023 ARRS ANNUAL MEETING - ABSTRACTS

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E2578. Spontaneous Intracranial Hypotension: Everything Radiologists Need to Know
Authors
  1. Seun Ah Lee; Hallym University Dongtan Sacred Heart Hospital
  2. Eun Kyung Khil; Hallym University Dongtan Sacred Heart Hospital
  3. Sang Won Jo; Hallym University Dongtan Sacred Heart Hospital
  4. Jihe Lim; Hallym University Dongtan Sacred Heart Hospital
Background
Spontaneous intracranial hypotension (SIH) results from spinal cerebrospinal fluid (CSF) leaking and the typical symptom of SIH is an orthopedic headache. The causes of spontaneous CSF leaks that lead to SIH include dural tears, leaking meningeal diverticula, and CSF–venous fistulas. Radiologic studies are an important role in the initial diagnosis of SIH and in its subsequent investigation and target management. For these, brain CT, brain MRI, spine MRI, and MRI myelography are the first choice imaging modalities. Therefore, this exhibit reviews the pathogenesis and clinical presentation of SIH and describes the typical neuroimaging manifestations on brain MRI, spine MRI, and MRI myelography, respectively.

Educational Goals / Teaching Points
To understand the pathophysiology of SIH. To introduce a radiologic protocol for diagnosing SIH, including brain and spine MR. To be familiar with various imaging findings of SIH on brain and spine MR.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Review SIH (pathophysiology, clinical features, classification, and diagnostic criteria). Review how to take a brain MR and diagnosis of SIH-brain (suggesting brain MR protocols, typical appearance of brain MR - diffuse pachymeningeal enhancement, descent of the cerebellar tonsil, brain stem sagging (mamillopontine distance, pontomesencephalic angle, interpeduncular angle, enlargement of the pituitary gland, subdural fluid collection or hemorrhage, engorgement of the dural venous sinus, and imaging mimickers). Review how to take a spine MR and what to diagnosis on SIH-spine (suggesting spine MR protocols, typical appearance of spine MR – epidural fluid collection: cervical/thoracic/lumbar, epidural venous engorgement, dural enhancement, meningeal diverticula, C1-2 sign), imaging mimickers, and additional radiologic conventional, CT and MR study of myelography.

Conclusion
Knowledge of the typical clinical symptoms and neuroradiologic findings of SIH may lead to a correct diagnosis and appropriate management.