Pathologic changes associated with intracranial hypotension and meningeal enhancement on MRI

We report a patient with a 6-week history of postural headache due to intracranial hypotension whose MRI revealed findings typical of this syndrome, including diffuse meningeal enhancement following gadolinium infusion. Biopsy revealed extensive fibrocollagenous proliferation in the leptomeninges without evidence of inflammation. The pathologic changes in this patient, which occurred soon after the onset of symptoms, are probably related to the striking meningeal enhancement seen in this syndrome.