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Neurology 1999;53:402
© 1999 American Academy of Neurology
Brief Communications

Absent pachymeningeal gadolinium enhancement on cranial MRI despite symptomatic CSF leak

B. Mokri, MD, J. L. D. Atkinson, MD, D. W. Dodick, MD, G. M. Miller, MD and D. G. Piepgras, MD

From the Departments of Neurology (Drs. Mokri and Dodick), Neurologic Surgery (Drs. Atkinson and Piepgras), and Diagnostic Radiology (Dr. Miller), Mayo Clinic, Rochester, MN.

Address correspondence and reprint requests to Dr. Bahram Mokri, Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905.

CSF leak is recognized to cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPMGE) on MRI. We report six patients with typical symptoms and documented CSF leaks without DPMGE. Two had normal meninges from the onset; one initially had normal meninges, but subsequently DPMGE developed. In three, the initially noted DPMGE resolved while they were still symptomatic with documented continued CSF leaks. Absent DPMGE does not rule out CSF leak. When clinical manifestations suggest this disorder, additional diagnostic studies should be pursued.




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