Delayed gadolinium enhancement in epidural space of the cervicothoracic spine in a patient with spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The spinal CSF leak may extend along a nerve root lateral to the spinal canal or collect within the epidural space of the spinal canal. On magnetic resonance (MR) imaging, the epidural fluid collections tend to be non-enhanced or mildly enhanced after gadolinium administration. We present an unusual case of SIH with delayed strong gadolinium enhancement in the epidural fluid collection. The subsequent vertebral angiography revealed tears at the anterior meningeal branch of the right vertebral artery. The mechanisms of the abnormal enhancement and arterial tears are discussed. CASE REPORT