This clinical scenario represents a severe clinical manifestation of SIH, which may represent sequela of more severe mechanical traction forces from brain sagging in the setting of CSF hypovolemia [62,63]. There are some limited reports of successful acute management of these critically ill patients with intrathecal saline infusions via lumbar drains, which may serve as a temporizing measure to raise CSF pressure and reverse obtundation [64-67]. The subsequent management of such patients is otherwise similar to patients with SIH without impaired consciousness and focuses on spine imaging to localize a source of leak that may be targeted for definitive treatment [24]. CT Complete Spine With IV Contrast There is no relevant literature to support CT complete spine with IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. Imaging of Suspected Intracranial Hypotension CT Complete Spine Without and With IV Contrast There is no relevant literature to support CT complete spine without and with IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. CT Complete Spine Without IV Contrast There is no relevant literature to support CT complete spine without IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. CT Myelography Complete Spine Although CT myelography complete spine can detect epidural contrast collections suggestive of dural defect or leaking meningeal diverticulum, MRI complete spine optimized with fluid sensitive sequences has been shown to detect epidural collections with equal sensitivity and is a preferred initial imaging option over CT myelography complete spine because it avoids the need for lumbar puncture [34,35].
Imaging of Suspected Intracranial Hypotension PCAs. This clinical scenario represents a severe clinical manifestation of SIH, which may represent sequela of more severe mechanical traction forces from brain sagging in the setting of CSF hypovolemia [62,63]. There are some limited reports of successful acute management of these critically ill patients with intrathecal saline infusions via lumbar drains, which may serve as a temporizing measure to raise CSF pressure and reverse obtundation [64-67]. The subsequent management of such patients is otherwise similar to patients with SIH without impaired consciousness and focuses on spine imaging to localize a source of leak that may be targeted for definitive treatment [24]. CT Complete Spine With IV Contrast There is no relevant literature to support CT complete spine with IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. Imaging of Suspected Intracranial Hypotension CT Complete Spine Without and With IV Contrast There is no relevant literature to support CT complete spine without and with IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. CT Complete Spine Without IV Contrast There is no relevant literature to support CT complete spine without IV contrast as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. CT Myelography Complete Spine Although CT myelography complete spine can detect epidural contrast collections suggestive of dural defect or leaking meningeal diverticulum, MRI complete spine optimized with fluid sensitive sequences has been shown to detect epidural collections with equal sensitivity and is a preferred initial imaging option over CT myelography complete spine because it avoids the need for lumbar puncture [34,35].