Radionuclide Cisternography in Detecting Cerebrospinal Fluid Leak in Spontaneous Intracranial Hypotension

Thomas, Damita; Menda, Yusuf; Graham, Michael M.

doi:10.1097/rlu.0b013e3181a7d118

Cited by 19 publications

(10 citation statements)

References 18 publications

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“…One of the forms with known causative factors is post-lumbar puncture intracranial hypotension [24]. When a low CSF pressure is present, the diagnostic tests and examinations may reveal the following: (1) low CSF opening pressure at lumbar puncture; (2) abnormal MRI findings, such as linear meningeal enhancement, sagging or sinking of the brain [25] and often of the cerebellar tonsils [26], subdural fluid collections, ventricular collapse [27], pituitary enlargement [28], and engorgement and enlargement of venous sinuses [34]; and (3) evidence of the leakage site on CT myelography, NMR myelography [21] and radionuclide cisternography [30]. Variants of the ''typical'' headache from low CSF pressure have also been identified, such as the acephalic form (without headache), the normal meninges form (without dural enhancement), and the normal pressure form (with normal CSF pressure) [31].…”

Section: Discussionmentioning

confidence: 99%

Cough headache secondary to spontaneous intracranial hypotension complicated by cerebral venous thrombosis

et al. 2011

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Cough headache may be the clinical manifestation, sometimes isolated, of an intracranial disease. There are several possible causes of secondary cough headache. The hypothesis that cough headache may be the expression of spontaneous intracranial hypotension has been advanced only recently. In fact, this would represent an exception to the rule that cough headache is generally secondary to conditions leading to an increase in intracranial pressure and/or volume. We report and discuss a case of cough headache secondary to spontaneous intracranial hypotension in an otherwise healthy 59-year-old man. The condition was complicated by cerebral venous thrombosis.

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Section: Discussionmentioning

confidence: 99%

Cough headache secondary to spontaneous intracranial hypotension complicated by cerebral venous thrombosis

et al. 2011

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“… 16 Radionuclide cisternography is considered to be the most accurate method for localizing the site of a CSF leak. 17 MR myelography is the most common noninvasive technology for detecting the site of a CSF leak, which can show pachymeningeal enhancement, extradural fluid extravasation extending to the paraspinal soft tissues, and engorgement of epidural venous plexuses. 18 Enhanced MRI can also show subdural fluid collections, diffuse pachymeningeal enhancement, obliteration of basal cisterns, descent of cerebellar tonsils, engorged cerebral venous sinuses, enlarged pituitary, and decreased size of the ventricles.…”

Section: Discussionmentioning

confidence: 99%

Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review

2016

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Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11–L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12–L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinicians that SIH can cause SDH and that EBP is a viable treatment option.

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“…Of these, radionuclide cisternography (RNC) is likely the most accurate, followed by MR myelography (19). Standard enhanced MR can show signs indicative of brain sag, including diffuse pachymeningeal enhancement, descent of cerebellar tonsils, obliteration of basal cisterns, subdural fluid collections, enlarged pituitary, engorged cerebral venous sinuses, and decreased size of ventricles (10).…”

Section: Discussionmentioning

confidence: 99%

Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.

Girgis¹,

Shing²,

DuPlessis³

2013

Turkish Neurosurgery

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Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF). Treatment is directed at sealing the site of leak, which is often difficult to localize. We present a case of near fatal SIH that was treated with thoracic epidural blood patching. A 47-yearold male presented with orthostatic headache and bilateral cranial nerve VI palsies progressing over several weeks. Brain magnetic resonance (MR) imaging showed features typical of SIH and identified an epidural collection stretching from spinal levels C6 to T4, but further imaging with MR myelography and radionuclide cisternography failed to identify a precise site of leak. The patient worsened in the hospital requiring craniotomy for evacuation of an evolving subdural hematoma (SDH). Epidural blood patch was performed at the T1-2 level, the presumed location of the leak due to presence of a bone spur on computed tomography and the large corresponding CSF collection. This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his SDH. Through this case and review of the literature, we aim to demonstrate that directed cervical or thoracic blood patching should be considered for SIH as an alternative to the conventional lumbar blood patch. KEywoRds: Epidural blood patch, Intracranial hypotension, Thoracic ÖZSpontan intrakraniyal hipotansiyonun (SIH) nedeni beyin omurilik sıvısının (BOS) spinal sızıntısıdır. Tedavi, sızıntı bölgesinin kapatılmasını hedefler ama bu bölgenin bulunması genellikle zordur. Torasik epidural kan yaması konmasıyla tedavi edilen neredeyse ölümcül bir SIH olgusu sunuyoruz. 47 yaşında bir erkek hasta birkaç haftadır ilerleyen ortostatik başağrısı ve bilateral VI. kraniyal sinir paralizisiyle geldi. Beyin manyetik rezonans (MR) görüntülemesi SIH için tipik özellikler gösterdi ve spinal C6 ila T4 seviyeleri arasında bir epidural sıvı toplanmasına işaret etti ama MR miyelografi ve radyonüklid sisternografi ile yapılan ek incelemeler tam olarak sızıntı yerini gösteremedi. Hastanın durumu hastanede kötüleşti ve giderek büyüyen bir subdural hematomun (SDH) boşaltılması için kraniyotomi gerekti. Bilgisayarlı tomografide bir kemik çıkıntısı bulunduğundan ve karşılık gelen büyük bir BOS birikimi olduğundan sızıntının varsayılan konumu olan T1-2 seviyesine epidural kan yaması uygulandı. Bunun sonucunda başağrısı ve kraniyal sinir paralizileri hızla iyileşti ve sonrasında SDH tamamen geçti. Bu olgu ve literatür derlemesi yoluyla servikal ve torasik kan yaması yerleştirmenin SIH durumunda konvansiyonel lumber kan yaması yerleştirmeye bir alternatif olarak düşünülmesi gerektiğini belirtiyoruz.

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Radionuclide Cisternography in Detecting Cerebrospinal Fluid Leak in Spontaneous Intracranial Hypotension

Cited by 19 publications

References 18 publications

Cough headache secondary to spontaneous intracranial hypotension complicated by cerebral venous thrombosis

Cough headache secondary to spontaneous intracranial hypotension complicated by cerebral venous thrombosis

Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review

Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.

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