Intracranial Hypotension Due to a Large Thoracic Meningocele

A 51-year-old female was admitted as an inpatient due to diplopia that lasted several minutes and did not vary depending on the direction of gaze. The patient did not complain of other symptoms such as headache. Physical examination revealed no focal neurological deficits and, in particular, no ocular motility disorder. Following administration of contrast medium, cranial magnetic resonance imaging (MRI) revealed meningeal enhancement (Figure a). Lumbar puncture revealed a CSF opening pressure of 0 mmH₂O in the presence of normal CSF findings (no evidence of meningitis or meningeosis neoplastica). Intracranial hypotension resulting from CSF loss syndrome is usually characterized by orthostatic headache, often accompanied by impaired hearing. In addition to meningeal enhancement, cranial MRI frequently : shows subdural hygromas. Finally, a chest MRI provided the causal explanation for the patient’s intracranial hypotension, that is, an 8.7-cm left-sided thoracic meningocele originating from T2–4 and extending into the pleural space (Figure b). We respected the wish of the patient—who was still symptom-free after 3 months (in particular, no dyspnea on exertion)—to undergo regular clinical follow-ups rather than surgical treatment.

Figure

Cranial MRI / Chest MRI

Dr. med. Payam Dibaj, Zentrum für Seltene Erkrankungen Göttingen (ZSEG), Georg-August-Universität Göttingen, [e-mail], Klinik für Neurologie, Klinikum Weser-Egge Höxter

Feder Haji, Prof. Dr. med. Mark Obermann, Klinik für Neurologie, Klinikum Weser-Egge Höxter

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Dibaj P, Haji F, Obermann M: Intracranial hypotension due to a large thoracic meningocele. Dtsch Arztebl Int 2023; 120: 192. DOI: 10.3238/arztebl.m2022.0370