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[A patient with spontaneous intracranial hypotension--comparison between MRI findings and meningeal pathology].

We report a 44-year-old woman with spontaneous intracranial hypotension (SIH) who developed an acute, severe, nonthrobbing headache. The headache remained more severe in the occipital region and was markedly worse with upright posture. Cerebrospinal fluid (CSF) examination revealed an opening pressure of 55 mmH2O, and the CSF contained 38 cells/mm3 and 57 mg/dl of protein. The results of other laboratory examinations were unremarkable. T1-weighted MR images (MRI) of the head revealed an extensive diffuse pachymeningeal gadolinium enhancement and bilateral subdural fluid accumulation. On the 21st hospital day, a meningeal biopsy was performed through a right parietal craniotomy. On histologic examination, the dural border cell layer demonstrated nonspecific granulation tissue with mild inflammatory changes. The remaining layers of the dura mater and the arachnoid membrane showed no obvious pathological changes. We speculated that the inflammatory changes of the dural border cell layer correspond to the zone of pachymeningeal gadolinium enhancement of the MRI. The granulation tissue of the dural border cell layer and subdural fluid accumulation may represent secondary reactive phenomena, and were suspected to have been caused by downward displacement of the brain due to decreased intracranial pressure.