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

Abstract

A 37-year-old male and an 18-year-old male presented with spontaneous spinal cerebrospinal fluid (CSF) leakage from multiple nerve root sleeves. Both patients suffered abrupt onset of intense headache followed by nausea, dizziness, and one patient with and one without positional headache. Radioisotope spinal cisternography of both patients revealed that the CSF leaks were not localized in a special zone but distributed to multiple spinal nerve root sleeves. Magnetic resonance (MR) myelography suggested that the spinal CSF column was fully expanded to the root sleeves. The extraspinal nerve bundles demonstrated numerous high intensity spots. Both patients were treated conservatively, and their symptoms resolved within one month. Repeat radioisotope cisternography and MR myelography confirmed the spine was normal after recovery. We suggest that spreading disruption of the arachnoid membrane occurs at the nerve root sleeves due to CSF overflow into the spinal canal.

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

“…We did not, however, encounter a similar finding in our 15 cases. Yoshimoto et al 27 and Chiapparini et al 15 reported patients with CSF leak that appeared similar to our cases. In the study by Yoshimoto et al, the spinal canal had fully expanded to the nerve root sleeves and high-intensity streaks were observed along with extraspinal nerve bundles on MRM.…”

“…Multiple simultaneous spinal CSF leaks in patients on their first presentation are well described in the literature. 18,21,27,29,30 There are limitations to our study. The most important one is that we used clinical criteria as the reference standard to evaluate the leakage.…”

“…23,24 A few sporadic cases have been reported of the detection of a CSF leak site in spinal CSF leak syndrome by using MRM. [25][26][27] Matsmura et al 26 reported a stripe of CSF leak along a nerve root. We did not, however, encounter a similar finding in our 15 cases.…”

Grados de Rotación Cérvico-Capital de la Población de Caldas, Colombia

“…El segmento cervical C1-C2 es el más móvil de la columna, con 47º de rotación (White al., 1975), aunque otros citan que el grado de rotación llega hasta 48,5º a la derecha y a la izquierda puede alcanzar 52.75º (Kapandji, 1998). En general, la rotación cervical alcanza de 45º a 50º , es decir que aproximadamente el 50% de la rotación del cuello (White & Panjabi, 1978) ocurre entre C1-C2 (White et al), vérte-bras que permiten arcos grandes de movilidad rotatoria (Yoshimoto et al, 2001;Chatain & Bustamante;Shapiro & Frankel, 1989). El resto está distribuido en las otras 5 vérte-bras cervicales (Chatain & Bustamante; Shapiro & Frankel).…”