Evaluation of spontaneous intracranial hypotension: assessment on ICP monitoring and radiological imaging

We describe two recent cases of spontaneous intracranial hypotension. A 38- year-old woman developed a severe postural headache. Magnetic resonance ima ging (MRI) showed marked dural enhancement. Histopathological findings of d ural biopsy showed numerous dilated vessels in the dura, rather than hypert rophic change. Lumber CSF pressure was 5 cmH(2)O and RI cisternography sugg ested CSF leakage. A 58-year-old woman with postural headache and vertigo h ad bilateral subdural haematoma associated with diffuse dural enhancement o n MRI. Lumber CSF monitoring confirmed persistent low pressure ranging from 0-5 cm H2O. MRI myelography revealed multiple CSF pouches along the whole spinal axis. CSF leakage was demonstrated on Radioisotope (RI) cisternograp hy. Both cases described in this report were diagnosed as spontaneous intra cranial hypotension caused by CSF leakage from spinal meningeal diverticula and were successfully treated by intravenous Factor XIII administration.