Deep Brain Swelling Secondary to Intracranial Hypotension

Introduction

Intracranial hypotension is a condition where the cerebrospinal fluid (CSF) pressure is < 6 cm of water or < 4.4 mmHg. It occurs due to CSF leakage from the neuraxis. There are two forms of intracranial hypotension: primary intracranial hypotension, also known as spontaneous intracranial hypotension, and secondary intracranial hypotension, which can result from CSF over-shunting, prior lumbar puncture, or post-traumatic causes. The most common clinical presentation is headache. Seizures in intracranial hypotension are rare, with only a few reported cases in the literature to date. Intracranial hypotension is diagnosed with an MRI of the brain, low CSF pressure on a lumbar puncture, or CSF leak on spinal imaging, such as a myelogram or spinal MRI. Here, we present a case of deep brain swelling secondary to intracranial hypotension caused by a high-volume lumbar puncture. Classical imaging findings on MRI include pachymeningeal enhancement, subdural fluid collection, engorgement of venous structures, reduction in the optic nerve sheath volume, sagging of the brain, and pituitary enlargement. Deep brain swelling secondary to intracranial hypotension is unusual. Moreover, this case demonstrates unusual imaging findings without evidence of subdural collection or meningeal enhancement.

Publication History

Received: 29 July 2023

Accepted after revision: 01 May 2024

Article published online:
22 May 2024