Intracranial Hypotension

Findings:
Smooth, uniformly thickened and enhancing dura.

Differential Diagnosis:
intracranial hypotension, dural fibrosis, sarcoid, TB, mets

Discussion:
The dural findings seen with intracranial hypotension are due to congestive changes caused by chronically low intracranial pressure. The pressure differential may be maintained by an occult CSF leak, and many patients can give a history of previous lumbar puncture or trauma. Uniform thickening of the dura is a characteristic feature, and the lack of nodularity or a basilar distribution can help distinguish this process from metastatic disease or TB/sarcoid. The cerebellar tonsils may occasionally sink through the foramen magnum, leading to an acquired Chiari I malformation.

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