Myelographic Techniques for the Detection of Spinal CSF Leaks in Spontaneous Intracranial Hypotension

Abstract

The purpose of this article is to review the imaging of spinal CSF leaks and to assist in the selection of appropriate imaging modalities in this condition.

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

“…Compliance, however, is not a fixed attribute with regards to the CSF compartment. 17 This individual variation may explain the fact that not all patients with SIH will have low CSF opening pressure, despite a common unifying problem of low CSF volume. 15 Compliance may be influenced by the spinal epidural venous plexus, which surrounds the thecal sac and is found to be dilated in some, but not all, patients with SIH.…”

Spontaneous Intracranial Hypotension Presenting as a "Pseudo-Chiari 1"

“…The overlap of symptomology between SIH and CM1 calls for the reliance on additional imaging to localize a CSF leak as seen in SIH. Computed tomography (CT) myelography is the preferred diagnostic modality to detect initial CSF leaks followed by dynamic CT myelography to differentiate high-flow from low-flow leaks [8]. CT myelography or digital subtraction myelography are specific for high-flow leaks, whereas magnetic resonance myelography with intrathecal gadolinium is preferred for low-flow leaks [8].…”

“…Computed tomography (CT) myelography is the preferred diagnostic modality to detect initial CSF leaks followed by dynamic CT myelography to differentiate high-flow from low-flow leaks [8]. CT myelography or digital subtraction myelography are specific for high-flow leaks, whereas magnetic resonance myelography with intrathecal gadolinium is preferred for low-flow leaks [8]. Treatment for SIH involves rest, caffeine, fluid supplementation, or an epidural blood patch (EBP).…”

Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF Pressure

“…If present, CSF leaks were further classified as either high-flow leaks, denoted by the presence of a pool of epidural contrast extending over Ͼ1 vertebral segment, or lowflow leaks, in which contrast leakage did not extend over Ͼ1 vertebral segment. 9 Initial image review was performed by a board-certified radiologist in the second year of a neuroradiology fellowship. Equivocal or borderline cases were reviewed by a second board-certified radiologist who holds a Certificate of Added Qualification in neuroradiology and has 12 years' experience interpreting brain MR imaging, including extensive experience in evaluating patients with SIH.…”