Non-Invasive Magnetic Resonance Myelography in Spontaneous Intracranial Hypotension

Idiopathic intracranial hypotension is a frequently overlooked headache entity, as it shares many clinical features with migraine without aura. Its diagnosis requires the documentation of headache that worsens after sitting or standing and low CSF pressure or the direct visualization of CSF leakage (1). Until recently, most available diagnostic imaging techniques entailed penetration of the lumbar subarachnoid space to measure the opening pressure or administer intrathecal agents. Despite the progressive refinement of contrast agents, side-effects of these techniques are still relatively common. The resultant iatrogenic dural defects further complicate diagnosis and effective management. Development of non-invasive imaging techniques is needed, but this is hampered by the complicated anatomy of the region and the dynamic process of CSF flow and absorption, which may not allow the demonstration of slow leaks that do not result in large fluid accumulations. We here report a patient with idiopathic intracranial hypotension, in whom the dural leaks were identified with SSFSE MR myelography.