Utility of Magnetic Resonance Imaging in Differentiating Cerebrospinal Fluid Leak from Middle Ear Effusion

2019 ◽  
Vol 161 (3) ◽  
pp. 493-498
Author(s):  
Joseph T. Breen ◽  
Colin R. Edwards ◽  
Rebecca S. Cornelius ◽  
J. Michael Hazenfield ◽  
Gavriel D. Kohlberg ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Middle Ear ◽  
Cerebrospinal Fluid Leak ◽  
Resonance Imaging ◽  
Middle Ear Effusion ◽  
Cerebrospinal Fluid Leaks ◽  
Mri Sequences ◽  
Fluid Leak ◽  
Ear Effusion

ObjectiveTo demonstrate the clinical utility, sensitivity, and specificity of standard magnetic resonance imaging (MRI) sequences in differentiating temporal bone cerebrospinal fluid leaks from all other middle ear effusions.Study DesignRetrospective imaging review.SettingAcademic medical center.SubjectsPatients with cerebrospinal fluid leaks or other middle ear effusions who also underwent MRI.MethodsPatients were assigned to cerebrospinal fluid leak and other effusion cohorts based on clinical course, findings at surgery/myringotomy, and beta-2 transferrin fluid analysis. Reviewers blinded to the clinical outcome examined T1-weighted, T2-weighted, diffusion-weighted, fluid-attenuated inversion recovery (FLAIR), and 3-dimensional (3D) acquired T2-weighted MRI sequences. For each sequence, fluid imaged in the temporal bone was graded as either similar or dissimilar in signal intensity to cerebrospinal fluid in the adjacent subarachnoid space. Signal similarity was interpreted as being diagnostic of a leak. Test characteristics in predicting the presence of a leak were calculated for each series.ResultsEighty patients met criteria (41 leaks, 39 other effusions). The 3D T2 series was 76% sensitive and 100% specific in diagnosing a leak, and FLAIR was 44% sensitive and 100% specific. The T1-weighted (73% sensitive, 69% specific), T2-weighted (98% sensitive, 5.1% specific), and diffusion-weighted (63% sensitive, 66% specific) series were less useful.ConclusionsMRI, with attention to 3D T2 and FLAIR series, is a noninvasive and highly specific test for diagnosing cerebrospinal fluid leak in the setting of an indeterminate middle ear effusion.

Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone

2021 ◽  
pp. 1-7
Author(s):  
T Hendriks ◽  
A Thompson ◽  
R Boeddinghaus ◽  
H E I Tan ◽  
J Kuthubutheen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Temporal Bone ◽  
Cerebrospinal Fluid Leak ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Leaks ◽  
Temporal Bones ◽  
Fluid Leak

Abstract Background and objective Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak. Methods A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed. Results Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1–10 mm). Conclusion Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.

scholarly journals Spontaneous Cerebrospinal Fluid Leak Presenting as Unilateral (Left-sided) Middle ear Effusion

2008 ◽  
Vol 87 (2) ◽  
pp. 79-80 ◽  
Author(s):  
Kavadi T. Rajkumar ◽  
Ahmed A. Orabi ◽  
Michael S. Timms
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Ear ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Middle Ear Effusion ◽  
Presenting Symptoms ◽  
Single Defect ◽  
The Right ◽  
Fluid Leak ◽  
Ear Effusion

Spontaneous leak of cerebrospinal fluid (CSF) into the middle ear occurs rarely and can easily be missed, especially in adults. Although the presenting symptoms can be subtle, early suspicion and confirmatory imaging can establish the diagnosis. Most previously reported cases of spontaneous CSF leak into the middle ear occurred on the right side. We report a case of left-sided single-defect spontaneous leak.

Correlations among brain and spinal MRI findings in spontaneous intracranial hypotension

Cephalalgia ◽  
2018 ◽  
Vol 38 (14) ◽  
pp. 1998-2005 ◽  
Author(s):  
Jr-Wei Wu ◽  
Yen-Feng Wang ◽  
Jong-Ling Fuh ◽  
Jiing-Feng Lirng ◽  
Shih-Pin Chen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Brain Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid Leak ◽  
Resonance Imaging ◽  
Imaging Signs ◽  
Fluid Leak

Objectives Several brain and spinal magnetic resonance imaging signs have been described in spontaneous intracranial hypotension. Their correlations are not fully studied. This study aimed to explore potential mechanisms underlying cerebral neuroimaging findings and to examine associations among spinal and brain magnetic resonance imaging signs. Methods We conducted a retrospective review of magnetic resonance myelography and brain magnetic resonance imaging records of patients with spontaneous intracranial hypotension. Categorical principal component analysis was employed to cluster brain neuroimaging findings. Spearman correlation was employed to analyze associations among different brain neuroimaging findings and between brain and spinal neuroimaging findings. Results In patients with spontaneous intracranial hypotension (n = 148), categorical principal component analysis of brain neuroimaging signs revealed two clusters: Cerebral venous dilation and brain descent. Among all brain magnetic resonance imaging signs examined, only midbrain-pons angle associated with anterior epidural cerebrospinal fluid collection length (surrogate spinal cerebrospinal fluid leak severity) (n = 148, Spearman’s ρ = −0.38, p < .001). Subgroup analyses showed that the association between midbrain-pons angle (within brain descent cluster) and spinal cerebrospinal fluid leak severity was presented in patients with convex margins of the transverse sinuses (n = 122, Spearman’s ρ = −0.43, p < .001), but not in patients without convex margins (n = 26, Spearman’s ρ = −0.19, p = .348). The association between severity of transverse sinus distension and spinal cerebrospinal fluid leak severity was only presented in patients without convex margins (n = 26, Spearman’s ρ = 0.52, p = .006). Conclusion This study indicates that there are two factors behind the brain neuroimaging findings in spontaneous intracranial hypotension: Cerebral venous dilation and brain descent. Certain brain neuroimaging signs correlate with spinal cerebrospinal fluid leakage severity, depending on different circumstances.

Delayed cerebrospinal fluid leak after penetrating cervical trauma

Trauma ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 63-65 ◽  
Author(s):  
Charles Fredericks ◽  
James R Yon ◽  
John Kubasiak ◽  
Anupam Basu ◽  
Kimberly Nagy ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Stab Wound ◽  
Cervical Spinal Cord ◽  
Cerebrospinal Fluid Leak ◽  
Resonance Imaging ◽  
Cervical Trauma ◽  
Cord Injury ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

Stab wound injury to the cervical spinal cord is a rare occurrence and usually presents with immediate, disastrous, and permanent neurological consequences. Rarer, and potentially as severe, is the complication of a delayed cerebrospinal fluid leak following a stab wound to the cervical spine. In this case, magnetic resonance imaging demonstrates a cerebrospinal fluid leak that extends to the skin with injury to the posterior dura at the C1/C2 level. Epidemiology and management of penetrating cervical spinal cord injury and delayed cerebrospinal fluid leaks are discussed.

Classification of Spontaneous Cerebrospinal Fluid Middle Ear Effusion: Review of Forty-Nine Cases

1985 ◽  
Vol 93 (5) ◽  
pp. 625-634 ◽  
Author(s):  
J. Gail Neely
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Ear ◽  
English Literature ◽  
Type I ◽  
Otic Capsule ◽  
Test Results ◽  
Middle Ear Effusion ◽  
Therapeutic Implications ◽  
Ear Effusion

This article presents a classification system of spontaneous cerebrospinal fluid middle ear effusion to facilitate early diagnosis and lesion localization for surgical correction. Thirty-eight articles containing case histories of 45 patients with spontaneous cerebrospinal fluid middle ear effusion reported in the English literature from 1913 to 1983 were reviewed. Four additional personal cases, representing the largest single series, are described in detail. Classification of these cases into the following three types has been possible: (type I, abnormal connections through the otic capsule; type II, abnormal connections adjacent to the otic capsule; and type III, abnormal connections distant from the otic capsule. The diagnostic and therapeutic implications of each type are unique. Age, auditory and vestibular test results, and computerized or hypocycloldal tomography differentiate the three.

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