A case of spontaneous intracranial hypotension in a 45-year-old male with headache, behavior changes and altered mental status

Radiology Case Reports

article

Sukhman Kaur¹  Kihyun Kwon¹  Sudha Ramachandran¹  Leszek Pisinski¹  Alan Krauthamer¹ 

[1] Harlem Hospital Center/Columbia University Irving Medical Center

关键词: Spontaneous intracranial hypotension;    Orthostatic headache;    CSF leak;    Sagging midbrain;    Dural tear;    Frontotemporal brain sagging syndrome;   

DOI  :  10.1016/j.radcr.2022.03.075

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

Spontaneous intracranial hypotension is a rare disease that results from low cerebrospinal fluid (CSF) volume caused by leakage of CSF from the spine in the absence of lumbar puncture , spine surgery, or intervention. The most common presentation is the headache that is usually but not invariably orthostatic. The underlying pathology is a CSF leak resulting from dural weakness involving the nerve root sleeves, ventral dural tears associated with calcified disc herniations , or CSF venous fistula . In severe cases, neuropsychiatric symptoms and changes in mental status may develop. Some case reports also mention gait disturbances, slurred speech , and urinary incontinence . The constellation of neuropsychiatric symptoms similar to behavior variant frontotemporal dementia in the presence of “brain sag” on MRI is known as frontotemporal brain sagging syndrome, first described by Wicklund et al. (4). The disease presents a diagnostic challenge to the primary care physicians, who are the first to see these patients. Brain and spine imaging is key to diagnoses but requires a high index of suspicion, as very rarely are all classic findings of intracranial hypotension present in the same patient. Here we discuss a case of spontaneous intracranial hypotension in a 45-year-old male patient who presented with headache, drowsiness, incoherent speech, behavior symptoms, and altered mental status.

【 授权许可】

CC BY|CC BY-NC-ND