Relationship Between Findings on Brain MRI and Prognosis in
Patients With Spontaneous Intracranial Hypotension

J Korean Neurol Assoc > Volume 32(1); 2014 > Article

Journal of the Korean Neurological Association 2014;32(1): 14-18.

자발두개내압저하 환자에서 뇌자기공명영상 결과와 예후의 상관관계

박명호, 김병채 최성민 김동은 최강호 김준태 윤 웅 a 남태승 이승한 박만석 김명규 조기현

전남대학교 의과대학 신경과학교실, 영상의학과학교실 a

Relationship Between Findings on Brain MRI and Prognosis in Patients With Spontaneous Intracranial Hypotension

Myung-Ho Park

Department of Neurology and Radiology , Chonnam National University Medical School, Gwangju, Korea

Abstract

Background: The outcome of spontaneous intracranial hypotension (SIH) is unpredictable and some patients have persistent and often incapacitating symptoms. This study was aimed to investigate whether abnormalities on initial magnetic resonance imaging (MRI) can predict the outcome in patients with SIH.
Methods: We retrospectively included 44 patients with SIH. Brain MRI was available for all patients. Treatment consisted of conservative treatment and/or high-volume epidural blood patching. Patients were divided into two groups: favorable or non-favorable group. Favorable group was defined as clinical improvement by conservative therapy or one trial of autologous epidural blood patching; non-favorable group as more than two week of admission, two or more trials of autologous epidural blood patching, or relapse of orthostatic headache.
Results: Twenty-one (48%) of 44 patients were classified as the favorable group. The non-favorable group had several abnormal findings on brain MRI (16 cases vs. 5 cases in favorable group, p<0.003), including platybasia (1), skull base tumor (1), Chiari I malformation (1), diffuse mild thickening and enhancement of dural and epidural layer of thoracic spine (1), pituitary enlargement (3), sagging brain (3) and subdural hemorrhage (4). In the non-favorable group, 13 out of 23 patients (57%) showed pachymeningeal enhancement in brain MRI (2 patients in favorable group, p<0.001).
Conclusions: Brain MRI abnormalities were more frequently related with non-favorable outcomes in SIH. Pachymeningeal enhancement in particular could suggest an unfortunate prognosis. Key Words: Spontaneous intracranial hypotension, Pachymeningeal enhancement, Epidural blood patch