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Images in Neurology
June 2002

Spontaneous Intracranial Hypotension

Arch Neurol. 2002;59(6):1027. doi:10.1001/archneur.59.6.1027

A 50-YEAR-OLD woman, previously in good health, had a 6-week history of progressively worsening headache. Her symptoms markedly worsened on sitting or standing and were somewhat alleviated when she lay down. Neurologic examination results were normal apart from some neck stiffness.

Initial cranial computed tomographic (CT) scan results (not shown) were normal. Cerebrospinal fluid (CSF) opening pressure measured by lumbar puncture in the recumbent position was 3 cm of water. Magnetic resonance imaging (MRI) (Figure 1) revealed a general descent of the brain accompanying a Chiari type I malformation, expansion of the sellar contents, and bilateral subdural hygromas. Gadolinium contrasted views demonstrated striking, diffuse, pachymeningeal, and dural venous sinus enhancement.