Cerebrospinal Fluid Leakage in Intracranial Hypotension Syndrome: Usefulness of Indirect Findings in Radionuclide Cisternography for Detection and Treatment Monitoring

Morioka, Tomoaki; Aoki, Takatoshi; Tomoda, Yoshitaka; Takahashi, Hiroyuki; Kakeda, Shingo; Takeshita, Iwao; Ohno, Masato; Korogi, Yukunori

doi:10.1097/rlu.0b013e318162d955

Cited by 25 publications

(28 citation statements)

References 17 publications

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“…Radionuclide cisternography has been used extensively for many decades in the evaluation of SIH (99–101). However, its usefulness is relatively limited because of poor resolution.…”

Section: Diagnosismentioning

confidence: 99%

“…The exact site of the CSF leak remains obscure in as many as one‐third of patients with proven leaks at myelography. Typical findings of radionuclide cisternography include early accumulation of tracer in the kidneys and bladder, slow accent along the spinal axis and a paucity of activity over the cerebral convexities (99–101). In our practice, radionuclide cisternography is rarely utilized.…”

Section: Diagnosismentioning

confidence: 99%

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Spontaneous Spinal Cerebrospinal Fluid Leaks

2008

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Spontaneous intracranial hypotension is an uncommon but not rare cause of new onset daily persistent headaches. A delay in diagnosis is the norm. Women are affected more commonly than men and most are in the fifth or sixth decade of life. The underlying cause is a spontaneous spinal cerebrospinal fluid (CSF) leak. Typically the headache is orthostatic in nature but other headache patterns occur as well. Associated symptoms are common and include neck pain, a change in hearing, diplopia, facial numbness, cognitive abnormalities and even coma. Typical imaging findings consist of subdural fluid collections, pachymeningeal enhancement, pituitary hyperaemia and brain sagging, but magnetic resonance imaging may be normal. Myelography is the study of choice to identify the CSF leak but is not always necessary to make the diagnosis. Treatment consists of bedrest, abdominal binder, epidural blood patching, percutaneous fibrin glue injection or surgical CSF leak repair. Outcomes have been poorly studied.

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“…Radionuclide cisternography has been used extensively for many decades in the evaluation of SIH (99–101). However, its usefulness is relatively limited because of poor resolution.…”

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Spontaneous Spinal Cerebrospinal Fluid Leaks

2008

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“…In particular, RICG is considered to be useful because it can evaluate not only the direct signs of leakage but also indirect signs and allows quantitative analysis (12,13). However, RICG carries a risk of iatrogenic CSF leakage (ICSFL), even when the puncture is performed carefully using a fine needle, and ICSFL can mimic SIH, leading to misdiagnosis (14).…”

Section: Introductionmentioning

confidence: 97%

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

et al. 2012

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“…Morioka and colleagues 28 looked in more detail at the direct and indirect signs of CSF leaks. A total of 67 patients with clinically suspected SIH underwent RNC, and 27 patients were found to have direct findings of CSF leakage; i.e.…”

Section: Radionuclide Cisternography (Rnc)mentioning

confidence: 99%

Spontaneous Intracranial Hypotension: Recommendations for Management

Amoozegar

Guglielmin

et al. 2013

Can. J. Neurol. Sci.

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. Nous n'avons trouvé aucun essai clinique ou ligne directrice sur le traitement de l'hypotension intracrânienne spontanée (HIS) lors d'une recherche de la littérature. Nous avons élaboré des recommandations sur le diagnostic et le traitement de l'HIS fondées sur la littérature disponible et l'avis d'experts. Chez les cas typiques, nous recommandons de procéder à une IRM cérébrale avec gadolinium pour confirmer le diagnostic et de prescrire un traitement conservateur pour une période de temps allant jusqu'à deux semaines. Si le patient demeure symptomatique, on devrait envisager de faire jusqu'à trois blood patches épidurales lombaires non dirigées. Si ce traitement ne donne pas de résultat, une myélographie non effractive par résonance magnétique, une cisternographie isotopique, une myélographie par résonance magnétique avec gadolinium intrathécal ou une myélographie par tomodensitométrie devrait être effectuée afin de localiser la fuite. Si la fuite est localisée, on devrait envisager de faire des blood patches dirigées suivies de l'administration d'un scellant de fibrine ou avoir recours à la neurochirurgie si nécessaire. Chez les cas atypiques au point de vue clinique, qui ont une IRM cérébrale normale, on devraient essayer de localiser la fuite. Des blood patches dirigées peuvent être utilisés si la fuite est localisée. Des blood patches non dirigées ne devraient être utilisées que s'il y a des signes indirects d'HIS.

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Cerebrospinal Fluid Leakage in Intracranial Hypotension Syndrome: Usefulness of Indirect Findings in Radionuclide Cisternography for Detection and Treatment Monitoring

Abstract: Indirect findings of radionuclide cisternography, especially early visualization of bladder activity, may be useful in the diagnosis and posttreatment follow-up of CSF leakage.

Cited by 25 publications

References 17 publications

Spontaneous Spinal Cerebrospinal Fluid Leaks

Spontaneous Spinal Cerebrospinal Fluid Leaks

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

Spontaneous Intracranial Hypotension: Recommendations for Management

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