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Research ArticleSPINE

Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF Pressure

P.G. Kranz, T.P. Tanpitukpongse, K.R. Choudhury, T.J. Amrhein and L. Gray
American Journal of Neuroradiology July 2016, 37 (7) 1374-1378; DOI: https://doi.org/10.3174/ajnr.A4689
P.G. Kranz
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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T.P. Tanpitukpongse
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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K.R. Choudhury
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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T.J. Amrhein
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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L. Gray
aFrom the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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    Fig 1.

    Box-and-whisker plots comparing PCSF (cm H2O) with the presence or absence of individual brain imaging signs of SIH.

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    Fig 2.

    Box-and-whisker plots comparing PCSF (cm H2O) with the presence or absence of various myelographic patterns in SIH.

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    Table 1:

    Diagnostic criteria for SIH from Schievink et al1

    Criteria
    A) Orthostatic headache
    B) The presence of at least 1 of the following:
        1) Low opening pressure (≤60 mm H2O)
        2) Sustained improvement of symptoms after epidural blood patching
        3) Demonstration of an active spinal CSF leak
        4) Cranial MRI changes of intracranial hypotension (eg, brain sagging or pachymeningeal enhancement)
    C) No recent history of dural puncture
    D) Not attributable to another disorder
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    Table 2:

    Prevalence of imaging signs and concordance with low PCSFa

    Overall PrevalenceConcordant Sign and PCSFDiscordant Sign and PCSF
    Sign Absent, PCSF ≤6Sign Present, PCSF >6
    %No./Total%No./Total%No./Total%No./Total
    Dural enhancement8377/933936/9355/935652/93
    Brain sagging6160/995554/9999/993636/99
    Venous distension sign7575/994242/9988/994949/99
    Leak on myelogram5554/995554/991212/993333/99
    • ↵a Concordance is defined as the presence of the imaging sign when PCSF is low (≤6 cm H2O) or absence of the sign when PCSF is not low.

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American Journal of Neuroradiology: 37 (7)
American Journal of Neuroradiology
Vol. 37, Issue 7
1 Jul 2016
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Cite this article
P.G. Kranz, T.P. Tanpitukpongse, K.R. Choudhury, T.J. Amrhein, L. Gray
Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF Pressure
American Journal of Neuroradiology Jul 2016, 37 (7) 1374-1378; DOI: 10.3174/ajnr.A4689

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Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF Pressure
P.G. Kranz, T.P. Tanpitukpongse, K.R. Choudhury, T.J. Amrhein, L. Gray
American Journal of Neuroradiology Jul 2016, 37 (7) 1374-1378; DOI: 10.3174/ajnr.A4689
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  • Spontaneous Intracranial Hypotension Associated with Vascular Malformations
  • Diagnostic Performance of Renal Contrast Excretion on Early-Phase CT Myelography in Spontaneous Intracranial Hypotension
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  • MRI Findings after Recent Image-Guided Lumbar Puncture: The Rate of Dural Enhancement and Subdural Collections
  • Patient experience of diagnosis and management of spontaneous intracranial hypotension: a cross-sectional online survey
  • Monro-Kellie Hypothesis: Increase of Ventricular CSF Volume after Surgical Closure of a Spinal Dural Leak in Patients with Spontaneous Intracranial Hypotension
  • Spontaneous Intracranial Hypotension: Atypical Radiologic Appearances, Imaging Mimickers, and Clinical Look-Alikes
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    Current Pain and Headache Reports 2017 21 8
  • Spontaneous Intracranial Hypotension: A Review and Introduction of an Algorithm For Management
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    World Neurosurgery 2017 101
  • Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography
    R.I. Farb, P.J. Nicholson, P.W. Peng, E.M. Massicotte, C. Lay, T. Krings, K.G. terBrugge
    American Journal of Neuroradiology 2019
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    Radiologic Clinics of North America 2019 57 2
  • Time-Dependent Changes in Dural Enhancement Associated With Spontaneous Intracranial Hypotension
    Peter G. Kranz, Timothy J. Amrhein, Kingshuk Roy Choudhury, Teerath Peter Tanpitukpongse, Linda Gray
    American Journal of Roentgenology 2016 207 6
  • CT-guided Fibrin Glue Occlusion of Cerebrospinal Fluid–Venous Fistulas
    Mark D. Mamlouk, Peter Y. Shen, Mark F. Sedrak, William P. Dillon
    Radiology 2021 299 2

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