Spontaneous CSF Collection in the Cervical Spine may Cause Neurological Deficit and Intra-cranial Hypotension

Objective:a case is described of a spontaneously occurring cerebrospinal fluid collection in the ventral cervical spine which caused radiculopathy and spontaneous intracranial hypotension. Case:a sixty eight year old Caucasian man presented with a 2 year history of proximal upper limb weakness with a his-tory of trivial cervical trauma many years previously. Methods:the patient was investigated with blood tests for causes of peripheral neuropathy, nerve conduction and electro-myography studies, lumbar puncture and MRI of the brain and spine with contrast. Results:a cerebrospinal fluid collection was identified in the ventral cervical spinal cord causing mass effect associated with cord atrophy and there were signs of spontaneous intracranial hypotension on the MRI brain including subdural cere-brospinal fluid collections, meningeal enhancement and slumped posterior fossa. Conclusions:this is the first description of a spontaneous spinal fluid collection causing direct compression and cord sig-nal change, manifest as a motor deficit, with intracranial signs of spontaneous hypotension. Spinal imaging is recom-mended in cases of spontaneous intracranial hypotension and cerebrospinal fluid collections in the spine may rarely be a cause of radiculopathy in such cases.

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False localizing sign of C1–2 cerebrospinal fluid leak in spontaneous intracranial hypotension

Journal of Neurosurgery ◽

10.3171/jns.2004.100.4.0639 ◽

2004 ◽

Vol 100 (4) ◽

pp. 639-644 ◽

Cited By ~ 52

Author(s):

Wouter I. Schievink ◽

M. Marcel Maya ◽

James Tourje

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypotension ◽

Fluid Collection ◽

Spontaneous Intracranial Hypotension ◽

Cerebrospinal Fluid Leak ◽

Csf Leak ◽

Content Type ◽

The Mean ◽

Fluid Collections ◽

Fine Print

Object. Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is an important cause of new daily persistent headaches. Spinal neuroimaging is important in the treatment of these patients, particularly when direct repair of the CSF leak is contemplated. Retrospinal C1–2 fluid collections may be noted on spinal imaging and these are generally believed to correspond to the site of the CSF leak. The authors undertook a study to determine the significance of these C1–2 fluid collections. Methods. The patient population consisted of a consecutive group of 25 patients (18 female and seven male) who were evaluated for surgical repair of a spontaneous spinal CSF leak. The mean age of the 18 patients was 38 years (range 13–72 years). All patients underwent computerized tomography myelography. Three patients (12%) had extensive retrospinal C1–2 fluid collections; the mean age of this woman and these two men was 41 years (range 39–43 years). The actual site of the CSF leak was located at the lower cervical spine in these patients and did not correspond to the site of the retrospinal C1–2 fluid collection. Conclusions. A retrospinal fluid collection at the C1–2 level does not necessarily indicate the site of the CSF leak in patients with spontaneous intracranial hypotension. This is an important consideration in the treatment of these patients because therapy may be inadvertently directed at this site.

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Thoracic epidural blood patch with high volume blood for cerebrospinal fluid leakage of cervical spine (C2–3) complicated with spontaneous intracranial hypotension

Acta Anaesthesiologica Taiwanica ◽

10.1016/j.aat.2015.06.003 ◽

2015 ◽

Vol 53 (3) ◽

pp. 112-113 ◽

Cited By ~ 4

Author(s):

Yi-Shan Chuang ◽

Da-Tong Ju ◽

Tai-Hsiang Chiu ◽

Yi-Hsuan Huang ◽

Chen-Hwan Cherng ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Cervical Spine ◽

Intracranial Hypotension ◽

Epidural Blood Patch ◽

Spontaneous Intracranial Hypotension ◽

High Volume ◽

Cerebrospinal Fluid Leakage ◽

Thoracic Epidural ◽

Blood Patch ◽

Volume Blood

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Spontaneous Intracranial Hypotension and MRI

Rivista di Neuroradiologia ◽

10.1177/197140099801100209 ◽

1998 ◽

Vol 11 (2) ◽

pp. 203-206

Author(s):

I. Muras ◽

A. Scuotto ◽

M. Maisto ◽

F.P. Bernini

Keyword(s):

Intracranial Hypotension ◽

Medical Condition ◽

Spontaneous Intracranial Hypotension ◽

Bed Rest ◽

Csf Leak ◽

Meningeal Enhancement ◽

Csf Leakage ◽

Downward Displacement ◽

Fluid Collections ◽

The Brain

Postural headache due to low intracranial pressure is a well-known entity and is most commonly encountered following lumbar puncture. It may occur as a consequence of a medical condition (dehydratation, uremia, etc.) but in some cases no precipitating event is apparent and the intracranial hypotension is believed to have developed spontaneously. In such cases the underlying cause of the syndrome is rarely established and treatment is non specific. We describe three patients with spontaneous intracranial hypotension examined with MRI of the brain. Women are more commonly affected than men in the third or fourth decades of life. Schaltenbrand (1938) proposed three mechanisms by which spontaneous intracranial hypotension may be explained: diminished CSF production; CSF hyperabsorption, CSF leakage. The defect causing a CSF leak usually remains obscure. Several cases of diffuse meningeal enhancement on MRI have recently been described, probably due to meningeal hyperaemia resulting from the low CSF pressure. Subdural fluid collections have also been detected as a result of rupture of bridging veins due to the decrease in CSF volume and downward displacement of the brain. In our cases, MRI showed a diffuse dural thickening, hyperintense in T2. Spontaneous intracranial hypotension is often a self-limiting disease, responding well to bed rest and a generous intake of oral or parenteral fluid and salt.

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Quadriparesis due to the delayed formation of a compressive epidural cerebrospinal fluid collection following suboccipital craniectomy with duraplasty for Chiari malformation Type I

Journal of Neurosurgery Spine ◽

10.3171/spi-07/10/450 ◽

2007 ◽

Vol 7 (4) ◽

pp. 450-453 ◽

Cited By ~ 2

Author(s):

Daniel M. Oberer ◽

Oran S. Aaronson ◽

Joseph S. Cheng

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypotension ◽

Chiari Malformation ◽

Fluid Collection ◽

Spontaneous Intracranial Hypotension ◽

Type I ◽

Chiari Malformation Type I ◽

Suboccipital Craniectomy ◽

Neurological Insult

✓ The authors describe a previously undocumented complication of suboccipital craniectomy combined with duraplasty for the treatment of Chiari malformation Type I and propose techniques to prevent its occurrence. Although there have been reports of epidural pseudomeningoceles in the setting of spontaneous intracranial hypotension and intracranial hygromas following suboccipital craniectomy with duraplasty, the authors believe this case to be the first instance of quadriparesis caused by the delayed formation of a compressive epidural cerebrospinal fluid collection after suboccipital craniectomy with duraplasty. This complication is significant and must be recognized given the potential severity of neurological insult and the number of these procedures performed yearly in both the pediatric and adult populations.

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Case report: spontaneous intracranial hypotension in association with the presence of a false localizing C1-C2 cerebrospinal fluid leak

Surgical Neurology ◽

10.1016/j.surneu.2007.05.037 ◽

2008 ◽

Vol 70 (5) ◽

pp. 539-543 ◽

Cited By ~ 8

Author(s):

Jonathan T. Morgan ◽

Alexander J. Scumpia ◽

Alan A. Johnson ◽

Steven J. Schneider

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Cerebrospinal Fluid Leak ◽

Fluid Leak

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Comparison of the radioisotope cisternography findings of spontaneous intracranial hypotension and iatrogenic cerebrospinal fluid leakage focusing on chronological changes

Cephalalgia ◽

10.1177/0333102412459571 ◽

2012 ◽

Vol 32 (15) ◽

pp. 1131-1139 ◽

Cited By ~ 7

Author(s):

Keita Sakurai ◽

Minoru Nishio ◽

Kazuo Yamada ◽

Masashi Shimohira ◽

Yoshiyuki Ozawa ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage

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Brain volume changes in spontaneous intracranial hypotension: Revisiting the Monro-Kellie doctrine

Cephalalgia ◽

10.1177/0333102420950385 ◽

2020 ◽

pp. 033310242095038

Author(s):

Jr-Wei Wu ◽

Yen-Feng Wang ◽

Shu-Shya Hseu ◽

Shu-Ting Chen ◽

Yung-Lin Chen ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Brain Tissue ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Fluid Volume ◽

Tissue Volume ◽

Fixed Constant ◽

The Brain ◽

Cerebrospinal Fluid Volume

Objectives In the application of the Monro-Kellie doctrine in spontaneous intracranial hypotension, the brain tissue volume is generally considered as a fixed constant. Traditionally, cerebral venous dilation is thought to compensate for decreased cerebrospinal fluid. However, whether brain tissue volume is invariable has not yet been explored. The objective of this study is to evaluate whether brain tissue volume is fixed or variable in spontaneous intracranial hypotension patients using automatic quantitative methods. Methods This retrospective and longitudinal study analyzed spontaneous intracranial hypotension patients between 1 January 2007 and 31 July 2015. Voxel-based morphometry was used to examine brain volume changes during and after the resolution of spontaneous intracranial hypotension. Brain structure volume was analyzed using Statistical Parametric Mapping version 12 and FMRIB Software Library v6.0. Post-treatment neuroimages were used as surrogate baseline measures. Results Forty-four patients with spontaneous intracranial hypotension were analyzed (mean [standard deviation] age, 37.8 [8.5] years; 32 female and 12 male). The whole brain tissue volume was decreased during spontaneous intracranial hypotension compared to follow-up (1180.3 [103.5] mL vs. 1190.4 [93.1] mL, difference: −10.1 mL [95% confidence interval: −18.4 to −1.8 mL], p = 0.019). In addition, ventricular cerebrospinal fluid volume was decreased during spontaneous intracranial hypotension compared to follow-up (15.8 [6.1] mL vs. 18.9 [6.9] mL, difference: −3.2 mL [95% confidence interval: −4.5 to −1.8 mL], p < 0.001). Longer anterior epidural cerebrospinal fluid collections, as measured by number of vertebral segments, were associated with greater reduction of ventricular cerebrospinal fluid volume (Pearson’s r = −0.32, p = 0.036). Conclusion The current study found the brain tissue volume and ventricular cerebrospinal fluid are decreased in spontaneous intracranial hypotension patients. The change in ventricular cerebrospinal fluid volume, but not brain tissue volume change, was associated with the severity of spinal cerebrospinal fluid leakage. These results challenge the assumption that brain tissue volume is a fixed constant.

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Sinus Thrombosis in a Patient with Intracranial Hypotension: A Suggested Hypothesis of Venous Stasis

Interventional Neuroradiology ◽

10.1177/159101991101700218 ◽

2011 ◽

Vol 17 (2) ◽

pp. 248-251 ◽

Cited By ~ 17

Author(s):

K-W. Yoon ◽

M-K. Cho ◽

Y.J. Kim ◽

C.S. Cho ◽

S-K. Lee

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypotension ◽

Rare Case ◽

Sinus Thrombosis ◽

Fluid Collection ◽

Csf Leak ◽

Venous Stasis ◽

Sagittal Sinus ◽

Blood Patch ◽

Spine Mri

We describe the case of a 26-year-old man with orthostatic headache. Cerebral angiography revealed thrombosis in the sagittal sinus. Spine MRI showed cerebrospinal fluid collection at the C1–2 level. We performed blood patch and the symptoms disappeared. We report a rare case of intracranial hypotension caused by CSF leak and describe our hypothesis that SIH can change the velocity of cerebral blood flow and cause thrombosis.

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