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Congress: ECR26
Poster Number: C-17529
Type: Poster: EPOS Radiologist (educational)
Authorblock: S. Reddy K, S. R. Kankara, S. K. Deepalam, D. Jayanna, U. Nayak, S. G. G. KUMAR, C. Nagesh, A. Josephine, V. M. Tellis; Bangalore/IN
Disclosures:
Shravan Reddy K: Nothing to disclose
Shreyas Reddy Kankara: Nothing to disclose
Sai Kanth Deepalam: Nothing to disclose
Dhanush Jayanna: Nothing to disclose
Unnathi Nayak: Nothing to disclose
SHARATH G G KUMAR: Nothing to disclose
Chinmay Nagesh: Nothing to disclose
Arpitha Josephine: Nothing to disclose
Vilas Melrick Tellis: Nothing to disclose
Keywords: Neuroradiology brain, Neuroradiology spine, MR, MR-Angiography, Diagnostic procedure, Myelography, Cerebrospinal fluid, Diverticula, Haemodynamics / Flow dynamics
Learning objectives To illustrate the acute and chronic imaging spectrum of spontaneous intracranial hypotension (SIH). To classify spinal leak types and highlight their characteristic imaging patterns. To review key myelographic techniques for accurate leak localization and outline the role of interventional radiology in management.
Read more Background Spontaneous intracranial hypotension results from spinal CSF leakage and typically presents with orthostatic headache, although many patients have nonspecific symptoms, leading to frequent underdiagnosis. The estimated incidence of ~5 per 100,000 per year is likely underestimated due to limited clinical and radiologic recognition and the variable clinical presentations (1,2).PATHOPHYSIOLOGYAccording to the Monro–Kellie doctrine, the intracranial compartment maintains a fixed total volume of brain, CSF, and blood. When CSF volume decreases due to a spinal leak, compensatory expansion of the intracranial...
Read more Findings and procedure details IMAGING FINDINGS - BRAINAcute Imaging FindingsVenous Sinus EngorgementSeen in 75–93% of cases, CSF volume loss leads to compensatory venous expansion, producing bulging, convex transverse, and sigmoid sinus margins (normally flat or concave), best assessed at the mid-portion of the dominant transverse sinus, this is often the earliest imaging finding and the first to normalize after treatment(7). [fig 3] Subdural CollectionsPresent in 50–54% of patients. Results from transudation of fluid or rupture of small vessels due to brain sag. Collections range from thin hygromas to...
Read more Conclusion Spontaneous intracranial hypotension is an increasingly recognized yet often elusive condition, with rising detection driven by advances in imaging and improved clinical awareness. Prompt recognition of its characteristic brain and spine findings, along with the appropriate selection of myelographic techniques, is essential for accurate leak localization and effective treatment. Greater familiarity with these imaging patterns among general radiologists can significantly improve early diagnosis and patient outcomes. [fig 30]
Read more References Schievink WI, Maya MM, Jean-Pierre S, Nuño M, Prasad RS, Moser FG. A classification system of spontaneous spinal CSF leaks. Neurology. 2016 Aug 16;87(7):673–9. D’Antona L, Jaime Merchan MA, Vassiliou A, Watkins LD, Davagnanam I, Toma AK, et al. Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome: A Systematic Review and Meta-analysis. JAMA Neurol. 2021 Mar 1;78(3):329–37. Kranz PGG L; Malinzak, M D; Amrhein, TJ. Spontaneous intracranial hypotension: pathogenesis, diagnosis, and treatment. Neuroimaging Clin N Am. 2019;29(04):581–94. Farb RIN...
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