Semra DURAN, Bülent SAKMAN, Arzu ÖZSOY, Deniz Sözmen CILIZ, Hatice Gül Hatipoğlu ÇETİN, Mehtap ÇAVUSOĞLU

Spontan İntrakraniyal Hipotansiyon: Kranial ve Spinal MRG Bulguları

Amaç: Spontan intrakranial hipotansiyon, nadir görülen bir sendrom olup, düsük beyin omurilik sıvısı (BOS) basıncı ile iliskili ortostatik bas ağrısı ile karakterizedir. Bu çalısmanın amacı, spontan intrakranial hipotansiyonun kranial ve spinal magnetik rezonans görüntüleme (MRG) bulgularının kliniğimize basvuran hastalar esliğinde incelenmesidir. Gereç ve Yöntem: Subat 2013- Haziran 2014 tarihleri arasında kliniğimizde tanı alan 5 (4 kadın, 1 erkek) spontan intrakranial hipotansiyon olgusu çalısmaya dahil edildi. Hastaların gelis semptomları, kranial MRG bulguları ve bir hastanın ek olarak spinal MRG bulguları incelendi. Bulgular: Hastaların tümü ortostatik bas ağrısı ile basvurdu. Diğer semptomlar arasında vertigo, mide bulantısı ve tinnitus bulunmakta idi. Kontrastlı kranial MRG incelemesinde, tüm hastalarda pakimeningeal kontrast tutulumu, venöz yapılarda angorjman, subdural hematom, hipofizer hiperemi saptandı. Bir hastada bu bulgulara ek olarak, bilateral amigdala ve parahipokampal girusta inferiora doğru herniasyon mevcuttu. Diğer bir hastada ise spinal MRG'de ekstradural sıvı koleksiyonu ve venöz yapılarda belirginlesme saptandı. Sonuç: Ortostatik bas ağrısı tarifleyen olgularda ayırıcı tanıda spontan intrakranial hipotansiyon düsünülmelidir. MRG tipik bulguların gösterilmesinde ve tanının doğrulanmasında invaziv olmayan altın standart görüntüleme yöntemidir.

Spontaneous Intracranial Hypotension: Brain and Spinal MRI Findings

Aim: Spontaneous intracranial hypotension is a rare syndrome, characterized by orthostatic headache associated with a low cerebrospinal fluid pressure. The aim of this study is to examine the brain and spinal magnetic resonance imaging (MRI) findings of spontaneous intracranial hypotension among the cases presenting in our clinic. Material and Methods: 5 cases ( 4 females and 1 male) diagnosed with spontaneous intracranial hypotension in our clinic between February 1 st, 2013 and June 30th, 2014 were included in this study. The presenting symptoms, findings brain MRI of all patients and also spinal MRI of one patient were recorded. Results: All patients presented with orthostatic headache. The other associated symptoms were vertigo, nausea and tinnitus. Gadolinium- enhanced cranial MRI disclosed enhancement of the pachymeninges, engorgement of venous structures, subdural hematome, pituitary hyperemia in all patients. Downward herniation of bilateral amigdala and parahippocampal gyrus was observed in one of our patients. In another patient spinal MRI showed extradural fluid collection and venous engorgement. Conclusion: Spontaneous intracranial hypotension should be suspected in cases with orthostatic headache complaint. MRI is the non- invasive gold- standard imaging method in recognizing the typical findings and validation of the diagnosis.

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