Cisternographic Pattern of Spontaneous Liquoral Hypotension

Abstract

We describe five cases of headache due to spontaneous liquoral hypotension, the syndrome comprising sudden, intense and oppressive orthostatic holocranial headache. The headache improved in the recumbent position and was accompanied by nausea and sometimes vomiting. There was no history of lumbar puncture or previous trauma. CSF tension was low or negative. The CSF showed a raised protein content and increased red and white cell counts. CT scan was normal or showed a slit ventricular system. Improvement was complete three to eight weeks from onset. The treatment consisted of bed rest and oral and parenteral fluid replacement. An isotope cisternography carried out in all patients while the headache was present showed a cisternographic pattern characterized by a combination of premature elimination and failure to detect the isotope at the cerebral convexity. Scan images did not show CSF leakage at any site. This stereotyped reaction pattern suggests that CSF hyperabsorption is the most likely pathophysiological mechanism of this entity.

Detection of CSF Leak in Spinal CSF Leak Syndrome Using MR Myelography: Correlation with Radioisotope Cisternography

“…18 If there is no active leakage or if the size of the leakage is smaller than the resolution, no direct evidence of the leak is seen. 19,20 RIC offers a more panoramic view of the entire spine, even though the sensitivity of RIC is not very high. 21 Recent studies have reported the improved sensitivity of RIC in detecting CSF leak.…”

Multi-level Disruption of the Spinal Nerve Root Sleeves in Spontaneous Spinal Cerebrospinal Fluid Leakage. Two Case Reports.

“…Spontaneous intracranial hypotension appears as three distinctive patterns: Diffusion of tracer into the extracanalicular space from a defined level, which should correlate rupture of extradural menin- Spinal Nerve Root Sleeve Disruption in Spontaneous CSF Leakage geal cysts 1,18,[23][24][25] ; no leakage from the spinal CSF column, but early accumulation of the tracers in the urinary bladder before reaching the cranial cavity, 11,14,30) which can be described as``hyperabsorption'' rather than``leakage'' of CSF because of the rapid clearance of tracers without a perispinal hot spot 14) ; and diffuse leakage of tracer from multiple spinal root sleeves as illustrated in this case. One of seven cases of spontaneous spinal CSF leakages occurred diffusely from T-5 to T-9.…”

Cerebrospinal fluid volume depletion and its emerging clinical/imaging syndromes

“…13 A common observation is early appearance of radioactivity in the kidneys and urinary bladder. This should not be misinterpreted as a manifestation of increased CSF reabsorption, 33,57 as the radioisotope hardly reaches the brain convexities to be reabsorbed.…”

“…2,5,21,23,24,40 The introduction of radioisotope cisternography, 12,22,33,34,57 water-soluble myelography, and CT myelography provided the clinicians with more effective tools to diagnose and locate CSF leaks. In the 1990s we learned of the discovery of MR imaging-documented abnormalities in CSF volume depletion due to CSF leakage or CSF shunt overdrainage.…”