Downloads: 0
Case Studies | Radiology and Medical Imaging Sciences | Volume 15 Issue 3, March 2026 | Pages: 698 - 701 | India
Unmasking Spontaneous Intracranial Hypotension: Radiologic Clues to a Hidden CSF Leak
Abstract: Background: Spontaneous intracranial hypotension (SIH) is an increasingly recognised yet frequently under diagnosed cause of orthostatic headache resulting from spontaneous cerebrospinal fluid (CSF) leakage along the spinal dura. Reduction in CSF volume leads to characteristic intracranial imaging findings secondary to compensatory venous dilation and downward displacement of intracranial structures. Magnetic resonance imaging (MRI) of the brain serves as the primary diagnostic modality and typically demonstrates diffuse pachymeningeal enhancement, venous sinus engorgement, pituitary enlargement, and features of brain sagging such as reduced mamillopontine distance and pontomesencephalic angle. However, precise localisation of the CSF leak may remain difficult on MRI alone. CT cisternography plays a complementary role by enabling direct visualisation of dural defects and active CSF extravasation. Case presentation: We present a case of a 55-year-old female with chronic orthostatic headache in whom MRI demonstrated classical intracranial findings of SIH, while CT cisternography accurately localised a dural defect at the atlantoaxial region. This case highlights the importance of a multimodality imaging approach in the diagnosis and targeted management of spontaneous intracranial hypotension.
Keywords: spontaneous intracranial hypotension, cerebrospinal fluid leak, MRI brain, CT cisternography, pachymeningeal enhancement
How to Cite?: Dr. Vishnupriya, Dr. Rudresh Hiremath, Dr. Sreedivya, "Unmasking Spontaneous Intracranial Hypotension: Radiologic Clues to a Hidden CSF Leak", Volume 15 Issue 3, March 2026, International Journal of Science and Research (IJSR), Pages: 698-701, https://www.ijsr.net/getabstract.php?paperid=MR26309223752, DOI: https://dx.dx.doi.org/10.21275/MR26309223752