Korean J Radiol.  2011 Aug;12(4):499-503. 10.3348/kjr.2011.12.4.499.

Reversal in the Diameter of the Superior Ophthalmic Vein after an Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension

• Hsiao CY
• Tsai YF

• KMID: 1783217
• DOI: http://doi.org/10.3348/kjr.2011.12.4.499

Abstract

Spontaneous intracranial hypotension (SIH) is caused by single or multiple cerebrospinal fluid (CSF) leaks in the spine with the prototypical symptom of postural headache. One of the characteristic MRI features in SIH is intracranial venous engorgement. This report presents a case of SIH with engorgement of the bilateral superior ophthalmic veins (SOVs) which resume their normal diameters by the third day of successful epidural blood patches (EBPs). We define this phenomenon as the "reversal of the SOV" sign.

Keyword

Blood patch, epidural; Cerebrospinal fluid (CSF); Intracranial hypotension, spontaneous; Magnetic resonance imaging (MRI)

MeSH Terms

Aged
*Blood Patch, Epidural
Cerebrospinal Fluid Rhinorrhea/*complications
Diagnosis, Differential
Humans
Intracranial Hypotension/*diagnosis/etiology/*therapy
*Magnetic Resonance Imaging
Male
Orbit/*blood supply

Figure

• 

  Fig. 1 Characteristic MR imaging findings of spontaneous intracranial hypotension. A. Postcontrast coronal T1-weighted image shows thin and uniform thickening of dura and tentorium (long arrows), as well as bilateral subdural effusion (short arrows). B. Postcontrast sagittal T1-weighted image shows enlargement of pituitary gland with diffuse enhancement; so-called pituitary hyperemia (long arrow), and engorgement of superior sagittal sinus, straight sinus and internal cerebral vein, as well as so-called engorgement of venous structures (short arrows). C. Coronal T2-weighted image, obtained day before epidural blood patch after suffering from postural headache for few days, shows significant engorgement of bilateral superior ophthalmic veins (arrows), which measure about 6 mm in diameter on both sides. D. Spinal MR myelography (T2-weighted image, echo time = 750 ms, T4 level) disclosed abnormal fluid accumulation along nerve sheaths (more significant on left side), which is suggestive of cerebrospinal fluid leaks (arrows). E. Coronal T2-weighted image obtained on third day after epidural blood patch shows significant regression of bilateral superior ophthalmic vein diameters (arrows); approximately 2 mm in diameter on both sides compared to 6 mm before procedure. F. Spinal MR myelography shows blockage of cerebrospinal fluid leak. G. Coronal fluid attenuation inversion recovery image obtained on eleventh day after epidural blood patch shows mild dural thickening (short arrows) and persistent bilateral subdural collections without regression (long arrows). H. Sagittal T2-weighted image shows persistent engorgement of superior sagittal sinus, straight sinus, and internal cerebral vein (arrows) without regression. I. Coronal T2-weighted image shows stationary diameters of bilateral superior ophthalmic veins (arrows) without further engorgement. J. Coronal fluid attenuation inversion recovery image obtained about four months later after epidural blood patch shows complete resolution of bilateral subdural collections.

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