It should be noted that the venous sinus, pituitary gland, and optic nerve sheath findings are opposite of what is seen in IIH or intracranial hypertension, as expected. It should also be noted that these need to be interpreted in the appropriate clinical context of orthostatic headaches, because there are other diseases with overlapping imaging findings: downward displacement of cerebellar tonsils in Chiari type 1 malformation, subdural fluid collections due to trauma, and diffuse dural thickening due to inflammatory conditions such as immunoglobulin G4-related disease and neurosarcoidosis [43-45]. MRI Head Without IV Contrast There is no relevant literature to support the use of MRI head without IV contrast in the initial imaging evaluation of headache with features of intracranial hypotension; although some findings of SIH can be detected on noncontrast brain MRI, contrast-enhanced brain MRI is needed to evaluate for pachymeningeal enhancement. MRI Thoracic Spine With IV Contrast Although the primary purpose of spine imaging is to look for an extradural fluid collection that would be consistent with a dural tear, which does not require contrast, there may be scenarios where postcontrast imaging of the spine is reasonable, for example, when contrast is being administered for concurrent brain MRI or when contrast is needed to differentiate enhancing epidural venous distension from nonenhancing epidural fluid collection. MRI Thoracic Spine Without and With IV Contrast Although the primary purpose of spine imaging is to look for an extradural fluid collection that would be consistent with a dural tear, which does not require contrast, there may be scenarios where postcontrast imaging of the spine is reasonable, for example, when contrast is being administered for concurrent brain MRI or when contrast is needed to differentiate enhancing epidural venous distension from nonenhancing epidural fluid collection.
Headache PCAs. It should be noted that the venous sinus, pituitary gland, and optic nerve sheath findings are opposite of what is seen in IIH or intracranial hypertension, as expected. It should also be noted that these need to be interpreted in the appropriate clinical context of orthostatic headaches, because there are other diseases with overlapping imaging findings: downward displacement of cerebellar tonsils in Chiari type 1 malformation, subdural fluid collections due to trauma, and diffuse dural thickening due to inflammatory conditions such as immunoglobulin G4-related disease and neurosarcoidosis [43-45]. MRI Head Without IV Contrast There is no relevant literature to support the use of MRI head without IV contrast in the initial imaging evaluation of headache with features of intracranial hypotension; although some findings of SIH can be detected on noncontrast brain MRI, contrast-enhanced brain MRI is needed to evaluate for pachymeningeal enhancement. MRI Thoracic Spine With IV Contrast Although the primary purpose of spine imaging is to look for an extradural fluid collection that would be consistent with a dural tear, which does not require contrast, there may be scenarios where postcontrast imaging of the spine is reasonable, for example, when contrast is being administered for concurrent brain MRI or when contrast is needed to differentiate enhancing epidural venous distension from nonenhancing epidural fluid collection. MRI Thoracic Spine Without and With IV Contrast Although the primary purpose of spine imaging is to look for an extradural fluid collection that would be consistent with a dural tear, which does not require contrast, there may be scenarios where postcontrast imaging of the spine is reasonable, for example, when contrast is being administered for concurrent brain MRI or when contrast is needed to differentiate enhancing epidural venous distension from nonenhancing epidural fluid collection.