Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report

J Neurosurg. 2000 Mar;92(3):475-7. doi: 10.3171/jns.2000.92.3.0475.


Meningeal enhancement on magnetic resonance (MR) imaging is considered the hallmark radiological feature of intracranial hypotension. The authors report on a patient who exhibited progressively symptomatic intracranial hypotension due to a lumbar cerebrospinal fluid (CSF) leak, but in whom MR imaging demonstrated no pachymeningeal enhancement. This 24-year-old man presented with a 6-week history of progressive orthostatic headaches that were associated with photo- and phonophobia. Four weeks before the onset of the headaches, the patient had undergone a lumbar laminectomy. Brain MR images revealed subdural fluid collections and brain sagging; however, meningeal enhancement was not present. Myelography demonstrated a CSF leak at the site of the laminectomy. At surgery, a large dural tear was repaired. The patient recovered well from the surgery, with complete resolution of his headaches. The absence of meningeal enhancement on MR imaging does not exclude a diagnosis of symptomatic intracranial hypotension.

MeSH terms

  • Adult
  • Dura Mater / surgery
  • Fistula / surgery
  • Humans
  • Intervertebral Disc Displacement / surgery*
  • Intracranial Hypotension / diagnosis*
  • Intracranial Hypotension / surgery
  • Laminectomy*
  • Lumbar Vertebrae / surgery*
  • Magnetic Resonance Imaging*
  • Male
  • Meninges / pathology*
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / surgery
  • Reoperation