Diagnosis of spontaneous intracranial hypotension by using magnetic resonance myelography

2000 ◽  
Vol 92 (5) ◽  
pp. 873-876 ◽  
Author(s):  
Akira Matsumura ◽  
Izumi Anno ◽  
Hiroshi Kimura ◽  
Eiichi Ishikawa ◽  
Tadao Nose
Keyword(s):  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Direct Evidence ◽  
Spontaneous Intracranial Hypotension ◽  
Content Type ◽  
Highly Sensitive ◽  
Csf Leakage ◽  
Leakage Site ◽  
A Site ◽  
Mr Myelography

✓ The authors describe a case of spontaneous intracranial hypotension in which the leakage site was determined by using magnetic resonance (MR) myelography. This technique demonstrated the route of cerebrospinal fluid (CSF) leakage, whereas other methods failed to show direct evidence of leakage. Magnetic resonance myelography is a noninvasive method that is highly sensitive in detecting CSF leakage. This is the first report in which a site of CSF leakage was detected using MR myelography.

scholarly journals Intrathecal preservative-free normal saline challenge magnetic resonance myelography for the identification of cerebrospinal fluid leaks in spontaneous intracranial hypotension

2015 ◽  
Vol 123 (3) ◽  
pp. 732-736 ◽  
Author(s):  
Julius Griauzde ◽  
Joseph J. Gemmete ◽  
Aditya S. Pandey ◽  
Neeraj Chaudhary
Keyword(s):  
Normal Saline ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series ◽  
Csf Leak ◽  
Csf Leakage ◽  
Leakage Site ◽  
Safe Technique ◽  
Preservative Free ◽  
Mr Myelography

OBJECT A CSF leak can be difficult to locate in patients who present with spontaneous intracranial hypotension (SIH). The purpose of this case series was to describe the authors’ experience with intrathecal preservative-free normal saline challenge coupled with contrast-enhanced MR myelography (CEMRM), which was used to provoke and detect a CSF leakage site in patients with SIH. METHODS The authors performed a retrospective review of the records of patients who underwent preservative-free normal saline challenge followed by intrathecal gadolinium (Gd) contrast infusion and MR myelography from 2010 to 2012. RESULTS The records survey identified 5 patients who underwent 6 procedures. Intrathecal preservative-free normal saline challenge followed by CEMRM identified a CSF leak during 5 of the 6 procedures. Previous CT myelograms were available from 4 patients, which did not reveal a leakage site. A CT myelogram of 1 patient showed a single leak, but the authors’ saline challenge-CEMRM technique identified multiple additional leakage sites. Three patients exhibited transient postprocedural symptoms related to the saline infusion, but no long-term or permanent adverse effects related to the procedure were observed. CONCLUSIONS Instillation of preservative-free normal saline into the thecal sac followed by intrathecal Gd infusion is a safe technique that may increase the detection of a CSF leak on MR myelography images in patients with SIH.

Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension

2001 ◽  
Vol 94 (4) ◽  
pp. 642-645 ◽  
Author(s):  
Chikanori Inenaga ◽  
Tokutaro Tanaka ◽  
Naoki Sakai ◽  
Shigeru Nishizawa
Keyword(s):  
Computerized Tomography ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Upright Position ◽  
Breath Holding ◽  
Content Type ◽  
Radionuclide Cisternography ◽  
Csf Leakage ◽  
Upper Cervical ◽  
Fine Print

✓ The authors present the case of a 55-year-old man suffering from intractable spontaneous intracranial hypotension, in whom conservative treatment with 19 weeks of bed rest was not effective. In this period the patient twice underwent surgery for bilateral chronic subdural hematoma, a complication of spontaneous intracranial hypotension. Conventional radionuclide cisternography, magnetic resonance imaging, and computerized tomography myelography did not demonstrate cerebrospinal fluid (CSF) leakage. Repeated radionuclide cisternography with the patient in an upright position revealed leakage of the tracer at upper cervical levels. Computerized tomography myelography with breath holding also showed CSF leakage of the contrast medium bilaterally at upper cervical levels. The patient underwent surgery, and bilateral C-2 and C-3 spinal nerve root pouches were sealed off from the subarachnoid space with oxidized cellulose cotton and fibrin glue. Epiarachnoid spaces around the root sleeves were also sealed to ensure complete resolution of the CSF leakage. After the surgery, the patient was completely free of the disease. In the case of intractable persistent spontaneous intracranial hypotension, surgical treatment is preferable to long-term conservative management. To identify CSF leakage, radionuclide cisternography with the patient in the upright position is useful. When obvious leakage is encountered, surgical sealing of the lesion should be performed via a subarachnoid approach.

Broadening the clinical spectrum: unusual presentation of spontaneous cerebrospinal fluid hypovolemia

2003 ◽  
Vol 98 (4) ◽  
pp. 903-907 ◽  
Author(s):  
Dennis A. Nowak ◽  
Sven-Olaf Rodiek ◽  
Jürgen Zinner ◽  
Albrecht Guhlmann ◽  
Helge Topka
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Clinical Presentation ◽  
Spontaneous Intracranial Hypotension ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Imaging Characteristics ◽  
Blood Patch ◽  
Csf Leakage ◽  
Fine Print

✓ The syndrome of spontaneous intracranial hypotension is characterized by orthostatic headaches in conjunction with reduced cerebrospinal fluid (CSF) pressure or CSF volume, and characteristic magnetic resonance (MR) imaging findings. A 50-year-old man presented with a 1-year history of paroxysmal ataxia of gait and short attacks of blurred vision when he stood up from a recumbent position and began to walk. Orthostatic headache was not a feature of his clinical presentation. Magnetic resonance images of the brain revealed diffuse enhancement of the dura mater and hygromas over both cerebral convexities. Magnetic resonance images of the spine demonstrated dilated cervical epidural veins and dilation of the perimedullary veins. Radionuclide cisternography identified a CSF leakage that was localized to the T12—L1 level on subsequent myelograms and on computerized tomography scans obtained after the myelograms. An epidural blood patch was administered and visualized with tungsten powder. The patient's clinical symptoms and sites of disease on imaging completely resolved. The unusual clinical presentation in this case—paroxysmal ataxia of gait, lack of orthostatic headaches, and dilated epidural and perimedullary venous plexus—supports a recently noted broadening of both the clinical and imaging characteristics of spontaneous intracranial hypovolemia.

Spontaneous intracranial hypotension associated with transdural thoracic osteophyte reversed by primary dural repair

2005 ◽  
Vol 2 (5) ◽  
pp. 614-618 ◽  
Author(s):  
Devin K. Binder ◽  
Vahé Sarkissian ◽  
William P. Dillon ◽  
Philip R. Weinstein
Keyword(s):  
Intracranial Hypotension ◽  
Surgical Intervention ◽  
Median Sternotomy ◽  
Spontaneous Intracranial Hypotension ◽  
Imaging Features ◽  
Dural Repair ◽  
Content Type ◽  
Csf Leakage ◽  
Upper Thoracic ◽  
Csf Leaks

✓ Spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome associated with a specific set of clinical and imaging findings; however, determining the site of spinal cerebrospinal fluid (CSF) leakage in these patients is often difficult, and indications for surgical intervention need to be better defined. The authors report on a 55-year-old woman who presented with posture-related headache, disorientation, and memory impairment. Imaging features were consistent with SIH. Computerized tomography myelography demonstrated a large T2–3 anterior transdural osteophyte associated with a CSF fistula. After an unsuccessful trial of conservative therapy, the patient underwent median sternotomy, T2–3 discectomy and removal of osteophyte, which allowed adequate exposure for primary dural repair. Postoperatively, there was immediate and prolonged resolution of all of her symptoms. This case of SIH was caused by transdural penetration by an anterior osteophyte and CSF leakage in the upper thoracic spine, which was treated effectively by anterior exposure and primary dural repair. Aggressive surgical intervention may be required to treat upper thoracic CSF leaks refractory to other measures.

scholarly journals Targeted Epidural Blood Patch Treatment for Refractory Spontaneous Intracranial Hypotension in China

2017 ◽  
Vol 79 (03) ◽  
pp. 217-223 ◽  
Author(s):  
Fei-Fang He ◽  
Li Li ◽  
Min-Jun Liu ◽  
Tai-Di Zhong ◽  
Qiao-Wei Zhang ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Spontaneous Intracranial Hypotension ◽  
Persistent Symptoms ◽  
Ionic Contrast ◽  
Blood Patch ◽  
Csf Leakage ◽  
Whole Spine ◽  
Mr Myelography ◽  
Csf Leaks

Objective An epidural blood patch (EBP) is the mainstay of treatment for refractory spontaneous intracranial hypotension (SIH). We evaluated the treatment efficacy of targeted EBP in refractory SIH. Methods All patients underwent brain magnetic resonance imaging (MRI) with contrast and heavily T2-weighted spine MRI. Whole spine computed tomography (CT) myelography with non-ionic contrast was performed in 46 patients, and whole spine MR myelography with intrathecal gadolinium was performed in 119 patients. Targeted EBPs were placed in the prone position one or two vertebral levels below the cerebrospinal fluid (CSF) leaks. Repeat EBPs were offered at 1-week intervals to patients with persistent symptoms, continued CSF leakage, or with multiple leakage sites. Results Brain MRIs showed pachymeningeal enhancement in 127 patients and subdural hematomas in 32 patients. One hundred fifty-two patients had CSF leakages on heavily T2-weighted spine MRIs. CSF leaks were also detected on CT and MR myelography in 43 and 111 patients, respectively. Good recovery was achieved in all patients after targeted EBP. No serious complications occurred in patients treated with targeted EBP during the 1 to 7 years of follow-up. Conclusions Targeted and repeat EBPs are rational choices for treatment of refractory SIH caused by CSF leakage.

Contrast-enhanced MR myelography in spontaneous intracranial hypotension: description of an artefact imitating CSF leakage

2009 ◽  
Vol 19 (7) ◽  
pp. 1799-1808 ◽  
Author(s):  
Elke Hattingen ◽  
Richard DuMesnil ◽  
Ulrich Pilatus ◽  
Andreas Raabe ◽  
Timo Kahles ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Contrast Enhanced ◽  
Csf Leakage ◽  
Mr Myelography

The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography

Cephalalgia ◽  
2016 ◽  
Vol 36 (13) ◽  
pp. 1291-1295 ◽  
Author(s):  
Teshamae S Monteith ◽  
Stephen F Kralik ◽  
William P Dillon ◽  
Randall A Hawkins ◽  
Peter J Goadsby
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Ct Myelography ◽  
Leak Location ◽  
Perineural Cyst ◽  
Mr Myelography ◽  
Csf Leaks

Objective The objective of this report is to compare computed tomography (CT) and magnetic resonance (MR) myelography with radioisotope cisternography (RC) for detection of spinal cerebrospinal (CSF) leaks. Methods We retrospectively reviewed 12 spontaneous intracranial hypotension (SIH) patients; CT and RC were performed simultaneously. Three patients had MR myelography. Results CT and/or MR myelography identified CSF leaks in four of 12 patients. RC detected spinal leaks in all three patients confirmed by CT myelography; RC identified the CSF leak location in two of three cases, and these were due to osteophytic spicules and/or discs. RC showed only enlarged perineural activity. Only intrathecal gadolinium MR myelography clearly identified a slow leak from a perineural cyst. In eight remaining cases, the leak site was unknown; however, two of these showed indirect signs of CSF leak on RC. CSF slow leaks from perineural cysts were the most common presumed etiology; and the cysts were best visualized on myelography. Conclusion RC is comparable to CT myelography but has spatial limitations and should be limited to atypical cases.

Comparisons Between Heavily T2-Weighted MR and CT Myelography Studies in Two Patients with Spontaneous Intracranial Hypotension

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 653-657 ◽  
Author(s):  
P-H Tsai ◽  
J-L Fuh ◽  
J-F Lirng ◽  
S-J Wang
Keyword(s):  
Nerve Root ◽  
Intracranial Hypotension ◽  
Large Scale ◽  
Scale Validation ◽  
Spontaneous Intracranial Hypotension ◽  
Time Saving ◽  
Ct Myelography ◽  
Computed Tomographic ◽  
Csf Leakage ◽  
Mr Myelography

Our previous study demonstrated that heavily T2-weighted magnetic resonance (MR) myelography could successfully detect abnormal cerebrospinal fluid (CSF) collections in patients with spontaneous intracranial hypotension (SIH); however, its ability to demonstrate ongoing CSF leakage sites is uncertain. Currently, computed tomographic (CT) myelography is still considered the study of choice for such a purpose. In this study, we compared the results of the two imaging modalities in two patients with SIH. CSF leakages, such as C1-2 extraspinal collections, CSF along nerve root sleeves, and epidural fluid collections were noted on both studies with minor discrepancies. CSF collection along nerve root sleeves demonstrated by MR myelography was the most likely ongoing leakage site in comparison with CT myelography. Targeted epidural blood patches in both patients resulted in complete headache resolution. Noninvasive, non-contrasted and time-saving MR myelography is a promising study for patients with SIH. Further large-scale validation studies are needed.

Spinal dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension

1998 ◽  
Vol 88 (5) ◽  
pp. 912-918 ◽  
Author(s):  
N. Nicole Moayeri ◽  
John W. Henson ◽  
Pamela W. Schaefer ◽  
Nicholas T. Zervas
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Clinical Findings ◽  
Content Type ◽  
Blood Patch ◽  
Neoplastic Process ◽  
Dural Enhancement

✓ This report offers a description of typical changes seen on gadolinium-enhanced magnetic resonance (MR) imaging of the entire spine that indicate spontaneous intracranial hypotension (SIH). To the authors' knowledge, this is the first report of its kind. They describe three cases of SIH that were accompanied by dural enhancement throughout the neuraxis on imaging, with the evolution of associated subdural and epidural fluid collections in the spine. Recognition of this disorder is important to be able to distinguish it from an infectious or neoplastic process in which surgical intervention might be warranted. Evaluation using gadolinium-enhanced cranial and spinal MR imaging in patients with postural headaches and an 111In-labeled cerebrospinal fluid leak study are discussed. Treatment with an epidural blood patch is shown to be particularly effective, with resolution of the radiological and clinical findings.

Radiologic Assessment of Spinal CSF Leakage in Spontaneous Intracranial Hypotension

1999 ◽  
Vol 41 (6) ◽  
pp. 1091
Author(s):  
Chang Jin Han ◽  
Ji Hyung Kim ◽  
Jang Sung Kim ◽  
Sun Yong Kim ◽  
Jung Ho Suh
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Radiologic Assessment ◽  
Csf Leakage
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