49-year-old woman with a history of acute onset he...

What is the diagnosis for this 49-year-old woman with a history of acute onset headache 10 days prior?

A. Pseudotumor cerebri

B. Global hypoxic injury

C. Spontaneous intracranial hypotension

D. Subarachnoid hemorrhage

A.

B.

C.

---

?

?

?

---

Dignosis: Spontaneous Intracranial Hypotension

Patients with spontaneous intracranial hypotension typically present with postural headache, nausea, or lower cranial neuropathy due to brainstem sagging.
Usually, the cause is some form of spinal CSF leakage which may require an epidural blood patch.
Typical SIH may show small subdural hemorrhages involving the bilateral hemispheric convexities on axial CT (A, yellow arrows).
Other cause of headache to exclude include subarachnoid hemorrhage, venous sinus thrombosis or pseudotumor cerebri.
MRI confirms the diagnosis by showing classic sagging of the brain (B, white arrow) and brainstem (B, yellow arrows).
Postcontrast T1-weighted image shows diffuse dural thickening and enhancement (C, white arrows).

中文版：

女性，49岁，突发头疼10天。

诊断为？

A. 假脑瘤综合征

B. 大脑半球缺氧损伤

C. 自发性低颅压

D. 蛛网膜下腔出血

诊断：自发性低颅压

自发性低颅压患者典型表现：体位性头痛、恶心，以及由脑干下沉引起的下部颅神经症状。
常见病因为不同形式的脊柱脑脊液瘘，可通过硬膜外自体静脉血注射治疗。
典型SIH在CT可表现为双侧大脑半球突面少量硬膜下出血（A）。
需除外引起头痛的其他原因，如：蛛网膜下腔出血，静脉窦血栓或假脑瘤综合征。
MRI表现为大脑（B，白箭头）及脑干下沉（B,黄箭头），可证实该诊断。
T1WI增强扫描表现为硬脑膜弥漫性增厚、强化（C，白箭头）。

From AJNR Classic Case