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Ross
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### Selected Images
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*Graphic shows IH with distended dural sinuses <img src='/img/arrows/BS.png'/> and enlarged pituitary <img src='/img/arrows/BO.png'/> and herniated tonsils <img src='/img/arrows/WC.png'/>. Central brain descent causes midbrain slumping, inferiorly displaced pons, closed pons-midbrain angle <img src='/img/arrows/BC.png'/>, and splenium depressing ICV/vein of Galen junction <img src='/img/arrows/WS.png'/>.*
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*Graphic shows IH with distended dural sinuses <img src='img/arrows/BS.png'/> and enlarged pituitary <img src='img/arrows/BO.png'/> and herniated tonsils <img src='img/arrows/WC.png'/>. Central brain descent causes midbrain slumping, inferiorly displaced pons, closed pons-midbrain angle <img src='img/arrows/BC.png'/>, and splenium depressing ICV/vein of Galen junction <img src='img/arrows/WS.png'/>.*
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*Graphic shows IH with distended dural sinuses <img src='/img/arrows/BS.png'/> and enlarged pituitary <img src='/img/arrows/BO.png'/> and herniated tonsils <img src='/img/arrows/WC.png'/>. Central brain descent causes midbrain slumping, inferiorly displaced pons, closed pons-midbrain angle <img src='/img/arrows/BC.png'/>, and splenium depressing ICV/vein of Galen junction <img src='/img/arrows/WS.png'/>.*
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*Graphic shows IH with distended dural sinuses <img src='img/arrows/BS.png'/> and enlarged pituitary <img src='img/arrows/BO.png'/> and herniated tonsils <img src='img/arrows/WC.png'/>. Central brain descent causes midbrain slumping, inferiorly displaced pons, closed pons-midbrain angle <img src='img/arrows/BC.png'/>, and splenium depressing ICV/vein of Galen junction <img src='img/arrows/WS.png'/>.*
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*T2 MR in a 57-year-old man treated for migraine headaches shows severe midbrain slumping <img src='/img/arrows/WC.png'/>, downwardly displaced cerebellar tonsils <img src='/img/arrows/WO.png'/>, and "draping" of the hypothalamus over the dorsum sellae with mammillary bodies <img src='/img/arrows/WS.png'/> below the dorsum.*
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*T2 MR in a 57-year-old man treated for migraine headaches shows severe midbrain slumping <img src='img/arrows/WC.png'/>, downwardly displaced cerebellar tonsils <img src='img/arrows/WO.png'/>, and "draping" of the hypothalamus over the dorsum sellae with mammillary bodies <img src='img/arrows/WS.png'/> below the dorsum.*
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*Sagittal T1 C+ FS MR in the same patient shows the severe midbrain slumping <img src='/img/arrows/WC.png'/> and inferiorly displaced tonsils. In addition, the pituitary gland appears "fat" <img src='/img/arrows/WO.png'/> and the dural venous sinuses are engorged <img src='/img/arrows/WS.png'/>.*
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*Sagittal T1 C+ FS MR in the same patient shows the severe midbrain slumping <img src='img/arrows/WC.png'/> and inferiorly displaced tonsils. In addition, the pituitary gland appears "fat" <img src='img/arrows/WO.png'/> and the dural venous sinuses are engorged <img src='img/arrows/WS.png'/>.*
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*Axial T1 C+ FS MR in the same patient shows a "fat" midbrain/pons <img src='/img/arrows/WO.png'/>, prominent superior ophthalmic veins <img src='/img/arrows/WC.png'/>, and engorged, outwardly convex transverse/sigmoid sinuses <img src='/img/arrows/WS.png'/>. No subdural hematomas were identified. Severe IH was treated successfully with a blood patch.*
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*Axial T1 C+ FS MR in the same patient shows a "fat" midbrain/pons <img src='img/arrows/WO.png'/>, prominent superior ophthalmic veins <img src='img/arrows/WC.png'/>, and engorged, outwardly convex transverse/sigmoid sinuses <img src='img/arrows/WS.png'/>. No subdural hematomas were identified. Severe IH was treated successfully with a blood patch.*
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*Axial NECT in a 55-year-old man with a severe headache in the ER shows downward herniation of both cerebellar tonsils <img src='/img/arrows/BO.png'/> through the foramen magnum.*
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*Axial NECT in a 55-year-old man with a severe headache in the ER shows downward herniation of both cerebellar tonsils <img src='img/arrows/BO.png'/> through the foramen magnum.*
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*More cephalad NECT in the same patient shows effacement of all basal cisterns, especially the suprasellar cistern <img src='/img/arrows/WO.png'/>. The midbrain appears "fat" <img src='/img/arrows/WS.png'/>. The imaging findings are suggestive of IH.*
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*More cephalad NECT in the same patient shows effacement of all basal cisterns, especially the suprasellar cistern <img src='img/arrows/WO.png'/>. The midbrain appears "fat" <img src='img/arrows/WS.png'/>. The imaging findings are suggestive of IH.*
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*Sagittal T1WI MR in the same patient shows changes of severe IH with midbrain slumping <img src='/img/arrows/WC.png'/>, downward tonsillar displacement <img src='/img/arrows/WS.png'/>, "fat" pituitary gland <img src='/img/arrows/WO.png'/>, and "draping" of the optic chiasm/hypothalamus over the dorsum sellae <img src='/img/arrows/BO.png'/>.*
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*Sagittal T1WI MR in the same patient shows changes of severe IH with midbrain slumping <img src='img/arrows/WC.png'/>, downward tonsillar displacement <img src='img/arrows/WS.png'/>, "fat" pituitary gland <img src='img/arrows/WO.png'/>, and "draping" of the optic chiasm/hypothalamus over the dorsum sellae <img src='img/arrows/BO.png'/>.*
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*Axial T2WI MR in the same patient shows the inferiorly displaced hypothalamus and 3rd ventricle obliterating the suprasellar cistern <img src='/img/arrows/WO.png'/>. The midbrain <img src='/img/arrows/WS.png'/> appears "fat" and elongated.*
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*Axial T2WI MR in the same patient shows the inferiorly displaced hypothalamus and 3rd ventricle obliterating the suprasellar cistern <img src='img/arrows/WO.png'/>. The midbrain <img src='img/arrows/WS.png'/> appears "fat" and elongated.*
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*Axial T1 C+ FS MR in the same patient shows smooth, diffuse dura-arachnoid enhancement <img src='/img/arrows/WS.png'/>, and an engorged, outwardly convex superior sagittal sinus <img src='/img/arrows/WC.png'/>.*
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*Axial T1 C+ FS MR in the same patient shows smooth, diffuse dura-arachnoid enhancement <img src='img/arrows/WS.png'/>, and an engorged, outwardly convex superior sagittal sinus <img src='img/arrows/WC.png'/>.*
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*Coronal T1 C+ FS MR in the same patient shows the diffuse dura-arachnoid enhancement <img src='/img/arrows/WS.png'/> extends into both internal auditory canals <img src='/img/arrows/WC.png'/>. The lateral ventricles have a more acute angle <img src='/img/arrows/WO.png'/> and appear "pulled down" toward the incisura. An epidural blood patch relieved the symptoms.*
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*Coronal T1 C+ FS MR in the same patient shows the diffuse dura-arachnoid enhancement <img src='img/arrows/WS.png'/> extends into both internal auditory canals <img src='img/arrows/WC.png'/>. The lateral ventricles have a more acute angle <img src='img/arrows/WO.png'/> and appear "pulled down" toward the incisura. An epidural blood patch relieved the symptoms.*
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### Additional Images
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*Sagittal T1WI C+ MR in a patient with severe IH shows obliteration of the suprasellar cistern, "sagging" and "fat" midbrain with closed angle between the peduncles/pons <img src='/img/arrows/WC.png'/>, dural enhancement, and tonsillar descent.*
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*Sagittal T1WI C+ MR in a patient with severe IH shows obliteration of the suprasellar cistern, "sagging" and "fat" midbrain with closed angle between the peduncles/pons <img src='img/arrows/WC.png'/>, dural enhancement, and tonsillar descent.*
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*Axial T1WI C+ MR in the same patient shows diffuse dural enhancement, hypodense extraaxial fluid collections, and small ventricles with medial deviation of the choroid and internal cerebral veins <img src='/img/arrows/WS.png'/> caused by midbrain descent.*
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*Axial T1WI C+ MR in the same patient shows diffuse dural enhancement, hypodense extraaxial fluid collections, and small ventricles with medial deviation of the choroid and internal cerebral veins <img src='img/arrows/WS.png'/> caused by midbrain descent.*
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*Coronal T1WI C+ MR in the same patient shows subdural fluid <img src='/img/arrows/WO.png'/> with diffuse dural thickening extending into both internal auditory canals <img src='/img/arrows/WS.png'/>. The lateral ventricles are pulled toward the midline.*
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*Coronal T1WI C+ MR in the same patient shows subdural fluid <img src='img/arrows/WO.png'/> with diffuse dural thickening extending into both internal auditory canals <img src='img/arrows/WS.png'/>. The lateral ventricles are pulled toward the midline.*
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*Coronal T2WI MR shows that the fluid collections are subdural hematomas of different ages. Drainage of the subdural hematomas without recognizing the underlying diagnosis of spontaneous IH caused worsening of the patient's symptoms.*
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*Axial T1WI C+ MR at the C2 level in a patient with spontaneous IH shows the draped curtain appearance of the markedly engorged epidural venous plexus <img src='/img/arrows/WO.png'/>. Brain MR (not shown) showed only mild dural enhancement.*
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*Axial T1WI C+ MR at the C2 level in a patient with spontaneous IH shows the draped curtain appearance of the markedly engorged epidural venous plexus <img src='img/arrows/WO.png'/>. Brain MR (not shown) showed only mild dural enhancement.*
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*Coronal T1WI C+ MR in the same patient shows an enlarged pituitary gland <img src='/img/arrows/WO.png'/> with mild dural thickening <img src='/img/arrows/WS.png'/>.*
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*Coronal T1WI C+ MR in the same patient shows an enlarged pituitary gland <img src='img/arrows/WO.png'/> with mild dural thickening <img src='img/arrows/WS.png'/>.*
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*Sagittal T1WI MR shows a rounded, "plump" pituitary gland <img src='/img/arrows/WS.png'/>, often seen in IH. Note the effaced suprasellar cistern with optic chiasm draped over the pituitary gland, classic "slumping" midbrain, with decreased angle between the pons and midbrain <img src='/img/arrows/WO.png'/>.*
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*Sagittal T1WI MR shows a rounded, "plump" pituitary gland <img src='img/arrows/WS.png'/>, often seen in IH. Note the effaced suprasellar cistern with optic chiasm draped over the pituitary gland, classic "slumping" midbrain, with decreased angle between the pons and midbrain <img src='img/arrows/WO.png'/>.*
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*Sagittal T1WI MR shows "sagging" midbrain, tonsillar herniation, and the optic chiasm "draped" over the dorsum sellae. T1WI C+ MR (not shown) demonstrated diffuse dural enhancement in this classic case of spontaneous IH.*
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*Axial T1WI C+ FS MR in a patient with spontaneous IH shows diffuse dura-arachnoid thickening <img src='/img/arrows/WS.png'/> from venous engorgement. Note extension into cerebellopontine angles <img src='/img/arrows/WO.png'/>.*
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*Axial T1WI C+ FS MR in a patient with spontaneous IH shows diffuse dura-arachnoid thickening <img src='img/arrows/WS.png'/> from venous engorgement. Note extension into cerebellopontine angles <img src='img/arrows/WO.png'/>.*
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*Axial T1WI C+ MR in the same patient after the blood patch shows complete resolution of dura-arachnoid enhancement.*
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