Case Notes
History
40 yo male with prior traumatic brain injury and craniotoy or subdural hematoma 4 years earlier. Now severe headaches.Exam
MR flair
Prior Study
Axial head T1-w enhanced MR1. Prior trauma and prior right craniotomy for subdural drainage.
2. Evidence of unexplained incisural downward displacement and significant tonsillar herniation. These findings and history added to the symptoms of severe headache are consistent with intracranial hypotension.
MR T1-w pre or post contrast MR
1. The combination of prior trauma and surgery and symptoms of unrelenting headache plus downward incisural and tonsillar herniation plus dilated dural sinuses is consistent with chronic CSF leak causing intracranial hypotension.