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.