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Kalamangalam et al¹ report an illustrative case and the magnetic resonance imaging features of spontaneous intracranial hypotension (SIH). This is a valuable contribution because the variability of clinical symptoms and insensitivity of initial computed tomographic (CT) scan results often form a diagnostic puzzle.

We recently admitted a 51-year-old man, previously in good health, who had a 6-week history of gradually progressive headache and a 1-week history of cognitive decline and ataxic gait. Neurological examination revealed striking fluctuations in consciousness level (Glasgow Coma Scale score, 9-15) with intermittent periods of somnolence and apneas as well as bilateral Babinski reflexes. The initial CT scan showed bilateral subdural effusions and enhancement of the pachymeninges. A subsequent magnetic resonance image showed a general descent of the brain with descent of the cerebellar tonsils into the foramen magnum, flattening of the pons against the clivus, and gadolinium-contrasted meningeal enhancement (Figure 1, A). We . . . [Full Text of this Article]

M. Weisfelt, MD; P. van den Munckhof, MD, MSc; C. B. Majoie, MD, PhD; G. J. Bouma, MD, PhD; D. A. Bosch, MD, PhD
Amsterdam, the Netherlands