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LETTER TO THE EDITOR
Year : 2013  |  Volume : 9  |  Issue : 4  |  Page : 756-757

Severe intracranial hypertension mimics intracranial hypotension radiologically


1 Section of Neurology, Taichung Veterans General Hospital, Taichung, China
2 Division of Haematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, China
3 Department of Radiology, Taichung Veterans General Hospital, Taichung; Department of Radiology, National Yang Ming University School of Medicine, Taipei, Taiwan, China

Date of Web Publication11-Feb-2014

Correspondence Address:
Hung-Chieh Chen
No. 160, Sec. 3, Chung Kang Rd., Taichung, Taiwan 40705
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.126491

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How to cite this article:
Tung H, Teng CLJ, Chen HC. Severe intracranial hypertension mimics intracranial hypotension radiologically. J Can Res Ther 2013;9:756-7

How to cite this URL:
Tung H, Teng CLJ, Chen HC. Severe intracranial hypertension mimics intracranial hypotension radiologically. J Can Res Ther [serial online] 2013 [cited 2019 Dec 16];9:756-7. Available from: http://www.cancerjournal.net/text.asp?2013/9/4/756/126491

Sir,

We report a case of lung cancer in a 55-year-old female who presented with progressive headache since past 3 months. She had vomiting, unsteady gait, and drowsiness since the past month. There was no fever or other neurological deficits. Brain magnetic resonance imaging (MRI) disclosed diffuse dural thickening with vivid contrast enhancement, slit ventricles, and tonsilar herniation [Figure 1], which were typical signs of intracranial hypotension. [1] However, the venous sinuses were irregular and collapsed with an engorged superior ophthalmic vein (SOV) [Figure 2]. Fundoscopy was performed and bilateral papilledema were noticed. Lumbar puncture revealed high opening pressure above 400 mm H 2 O. Diffused bony metastasis with dura involvement was diagnosed.
Figure 1: Postgadolinium T1 weighted image axial view (a) and midline sagittal view (b) showed diffused pachymeningeal enhancement, slit ventricles, and tonsilar herniation

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Figure 2: MR venography disclose irregular and collapsed venous
sinus. Engorged superior opththalmic vein is seen (arrow)


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Diffused pachymeningeal enhancement and brain descend are typical image characteristics for intracranial hypotension. Patients usually present with headache, especially orthostatic type. However, multiple diseases will present as pachymeningeal enhancement including transient postoperative changes, neoplasm, metastatic disease, secondary central nervous system (CNS) lymphoma, and granulomatous disease. [2],[3] Careful survey of clinical history and analyzing other imaging findings are crucial for correct diagnosis. Neoplasm or metastasis disease involving the dura matter may be focal or diffused. [2],[3] The intracranial pressure is usually increased. Small venous sinuses and engorged SOV demonstrated by using MR venography could give us a hint for elevated intracranial pressure.

 
 > References Top

1.Sainani NI, Lawande MA, Pungavkar SA, Desai M, Patkar DP, Mohanty PH. Spontaneous intracranial hypotension: A study of six cases with MR findings and literature review. Australas Radiol 2006;50:419-23.  Back to cited text no. 1
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2.Grabarz D, Bezjak A, Bordeleau L. Treating dural metastases mimicking intracranial hypotension. J Support Oncol 2007;5:423-4.  Back to cited text no. 2
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3.Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics 2007;27:525-51.  Back to cited text no. 3
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