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Wave-like appearance of diffuse pachymeningeal enhancement associated with intracranial hypotension

  • Diagnostic Neuroradiology
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Abstract

Diffuse pachymeningeal enhancement on magnetic resonance (MR) imaging is important in identifying spontaneous and secondary intracranial hypotension (IH) [cerebrospinal fluid (CSF) hypovolemia] in patients with postural headache, because CSF pressure at lumbar puncture is variable. We examined the pachymeningeal enhancement pattern in patients with IH. MR imaging findings of pachymeningeal enhancement were examined before and after treatment in seven consecutive patients with spontaneous IH and one patient with IH after lumbar puncture. Diffuse non-nodular dural enhancement was observed in all patients. Characteristic thick, uninterrupted, enhancement was observed, mainly in the dura of the frontal, temporal, and retroclival regions, and the tentorium. Thin and uninterrupted, or partially interrupted, enhancement was observed, mainly in the parieto-occipital region and cerebellar convexity. Curved linear enhancement was observed along the calvarium of all patients. A wave-like appearance, a clear pattern of dural unevenness parallel to the brain, was detected in the frontal and temporal regions, near the base, in all patients. A wave-like appearance, especially in the frontal and temporal base, may be a characteristic MR imaging indicator of IH.

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Acknowledgments

We thank Drs. Fumiaki Honda, Keishi Horiguchi, Yukitaka Tanaka, and Kaiei Kagoshima of Gunma University for helpful advice.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    M Tosaka, H. Fujimaki, A. Takahashi & N. Saito

  2. Department of Radiology, National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-8551, Japan

    N. Sato

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  1. M Tosaka
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  2. N. Sato
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  3. H. Fujimaki
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  4. A. Takahashi
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  5. N. Saito
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Correspondence to M Tosaka.

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Tosaka, M., Sato, N., Fujimaki, H. et al. Wave-like appearance of diffuse pachymeningeal enhancement associated with intracranial hypotension. Neuroradiology 47, 362–367 (2005). https://doi.org/10.1007/s00234-005-1366-8

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  • DOI: https://doi.org/10.1007/s00234-005-1366-8

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