Study Design. A case of diffuse pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension is presented.
Objective. To report a case of diffuse pachymeningeal gadolinium enhancement of the lumbar region and to show the importance of considering neuraxis hypotension in the differential diagnosis of this type of enhancement so as to avoid excessive invasive and noninvasive diagnostic testing.
Summary of Background Data. Diffuse pachymeningeal gadolinium enhancement of the lumbar region secondary to neuraxis hypotension has not been reported previously.
Methods. A case of diffuse pachymeningeal gadolinium enhancement of the lumbar region is presented in the context of clinical signs and symptoms replete with a history of cerebrospinal fluid diversion that strongly suggest neuraxis hypotension.
Results. The patient's clinical presentation and history of shunting implicated neuraxis hypotension as a cause of the diffuse dural enhancement.
Conclusion. Proper attribution of the dural gadolinium enhancement to neuraxis hypotension helped avoid a dural biopsy with its potential attendant morbidity. It is important to consider neuraxis hypotension in the differential diagnosis of diffuse pachymeningeal enhancement occurring anywhere in the central neuraxis to avoid unnecessary diagnostic testing with its attendant morbidity and cost.