# Duropathies as Unifying Concept—Part Two: A Narrative Overview of Clinical and Neuroradiological Features

## TL;DR

This paper reviews duropathies, a group of disorders involving spinal dural tears and CSF leaks, focusing on their clinical and imaging features to improve diagnosis and treatment.

## Contribution

The paper introduces a unifying framework for understanding duropathies and emphasizes the role of imaging in diagnosis.

## Key findings

- MRI and CT myelography are key for identifying spinal dural tears and CSF leaks.
- Spontaneous intracranial hypotension is marked by orthostatic headaches and specific imaging patterns.
- Arachnoid webs are frequently linked to syringomyelia and neurological complications.

## Abstract

Duropathies represent a spectrum of disorders associated with spinal dural tears and cerebrospinal fluid (CSF) leaks. Diagnosis and treatment is often complicated by overlapping clinical manifestations. This review aims to synthesize current literature on duropathies, focusing on their clinical, neuroradiological, and pathophysiological features. A comprehensive literature review was conducted, analyzing various conditions classified as duropathies, including spontaneous intracranial hypotension (SIH), superficial siderosis (SS), spinal cord herniation, and, as added issue, arachnoid webs. The review emphasized the importance of imaging techniques such as MRI and CT myelography in diagnosing these conditions. Duropathies can arise from congenital anomalies, trauma, and degenerative changes, with SIH being characterized by orthostatic headaches and neurological deficits. Imaging typically reveals specific patterns, such as a widened dorsal subarachnoid space and ventral displacement of the spinal cord. Syringomyelia was frequently associated with arachnoid webs, and complications like SS and bibrachial amyotrophy were noted in patients with persistent ventral spinal CSF leaks. The unifying concept of duropathies is proposed, emphasizing the need for timely intervention to mitigate long-term neurological consequences. Enhanced diagnostic strategies are crucial for improving patient outcomes, and a multidisciplinary approach is recommended for the management of these complex disorders. Further research is warranted to clarify the pathophysiological mechanisms underlying duropathies and to establish standardized treatment protocols.