The Radiopaedia Reading Room Podcast 44. Readful! Spontaneous intracranial hypotension with Lalani Carlton Jones
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Apr 1, 2024 Lalani Carlton Jones, a neuroradiologist and CSF leak expert, dives into the complexities of spontaneous intracranial hypotension (SIH). They discuss advancements in diagnosing CSF leaks, including dynamic CT myelography and the role of epidural blood patches. The conversation also highlights the challenges clinicians face in identifying symptoms and the importance of imaging techniques. With a blend of insight and humor, they emphasize ongoing education and improved patient care surrounding these intricate conditions.
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Missed Fistulas
- CSF venous fistulas were previously missed in patients with positive brain imaging for SIH.
- Increased recognition of fistulas now explains previously elusive cases.
CT Head Interpretation
- Consider SIH in patients with spontaneous headaches and subdural collections, even with minor trauma.
- Reformat CT head images in the sagittal plane to visualize brain sag, venous distension, and pituitary distension.
Pachymeningeal Enhancement
- Look for pachymeningeal thickening on MRI, even without contrast.
- Giving gadolinium helps visualize pachymeningeal thickening, a key finding in SIH.