Role of dynamic CT myelography in identifying the etiology of superficial siderosis

Kumar, Neeraj; Lindell, E. Paul; Wilden, Jessica A.; Davis, D. H.

doi:10.1212/01.wnl.0000172345.05810.14

Cited by 46 publications

(61 citation statements)

References 10 publications

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“…Limited experience suggests that repair of the defect may be associated with clinical stability or improvement, resolution of the intraspinal fluidfilled collection, and resolution of CSF evidence of subarachnoid bleeding. 2,28,29,31,36 Some reports have also noted an association between SS and CSF hypovolemia and low-pressure headache. 30,31,35 CSF hypovolemia (craniospinal hypotension) is a disorder that is frequently associated with dural defects, occasionally with intraspinal fluid collection of variable longitudinal extent and rarely with red blood cells (RBCs) or xanthochromia in the CSF.…”

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confidence: 99%

“…2,3,8,[19][20][21][22][23][24][25][26][27][28][29][30][31] Before the advent of MR imaging, approximately 40 cases had been reported in the world literature. 32 The diagnosis of SS had largely been postmortem or made during surgical exploration.…”

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confidence: 99%

“…8 In recent years, an extra-arachnoid longitudinally extensive intraspinal fluid-filled collection has been frequently noted in patients with SS. 2,3,[28][29][30][31]35,36 A CT myelogram, dynamic CT myelogram, or digital substraction myelogram can identify a dural defect that connects the intrathecal space with the fluid-filled collection. 29,35,36 The precise mechanism of bleeding in these cases is unknown.…”

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confidence: 99%

“…2,3,[28][29][30][31]35,36 A CT myelogram, dynamic CT myelogram, or digital substraction myelogram can identify a dural defect that connects the intrathecal space with the fluid-filled collection. 29,35,36 The precise mechanism of bleeding in these cases is unknown. Limited experience suggests that repair of the defect may be associated with clinical stability or improvement, resolution of the intraspinal fluidfilled collection, and resolution of CSF evidence of subarachnoid bleeding.…”

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Neuroimaging in Superficial Siderosis: An In-Depth Look

Kumar¹

2009

AJNR Am J Neuroradiol

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153

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SUMMARY:Despite extensive imaging, a source of bleeding is often not evident during the evaluation of patients with superficial siderosis (SS) of the central nervous system. An intraspinal fluid-filled collection of variable dimensions is frequently seen on spine MR imaging in patients with idiopathic SS. A similar finding has also been reported in patients with craniospinal hypotension. This review discusses the role of multitechnique imaging in the work-up of patients with SS and focuses on recent developments.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Neuroimaging in Superficial Siderosis: An In-Depth Look

Kumar¹

2009

AJNR Am J Neuroradiol

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153

161

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“…Patients with highflow fast spinal CSF leaks have significant debility related to low-pressure CSF syndrome or superficial siderosis of the CNS. 4,5,8,9,11,12 Detection of the exact site of leakage is difficult in patients with high-flow fast CSF leaks because of the rapid equilibration of intrathecal contrast with the epidural fluid collection. The identification and localization of low-flow slow leaks requires different techniques.…”

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Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes

Thielen

Sillery

Morris

et al. 2015

SPI

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OBJECT Precise localization and understanding of the origin of spontaneous high-flow spinal CSF leaks is required prior to targeted treatment. This study demonstrates the utility of ultrafast dynamic CT myelography for the precise localization of high-flow CSF leaks caused by spiculated spinal osteophytes. METHODS This study reports a series of 14 patients with high-flow CSF leaks caused by spiculated spinal osteophytes who underwent ultrafast dynamic CT myelography between March 2009 and December 2010. There were 10 male and 4 female patients, with an average age of 49 years (range 37–74 years). The value of ultrafast dynamic CT myelography in depicting the CSF leak site was qualitatively assessed. RESULTS In all 14 patients, ultrafast dynamic CT myelography was technically successful at precisely demonstrating the site of the CSF leak, the causative spiculated osteophyte piercing the dura, and the relationship of the implicated osteophyte to adjacent structures. Leak sites included 3 cervical, 11 thoracic, and 0 lumbar levels, with 86% of the leaks occurring from C-5 to T-7. Information obtained from the ultrafast dynamic CT myelogram was considered useful in all treated CSF leaks. CONCLUSIONS Spinal osteophytes piercing the dura are a more frequent cause of high-flow CSF leaks than previously recognized. Ultrafast dynamic CT myelography adds value beyond standard dynamic myelography or digital subtraction myelography in the diagnosis and anatomical characterization of high-flow spinal CSF leaks caused by these osteophytes. This information allows for appropriate planning for percutaneous or surgical treatment.

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Superficial Siderosis

Kumar¹

2007

Arch Neurol

132

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uperficial siderosis of the central nervous system results from hemosiderin deposition in the subpial layers of the brain and spinal cord. A clinical history of subarachnoid hemorrhage is often absent. Patients present with slowly progressive gait ataxia and sensorineural hearing impairment. A history of prior intradural surgery or trauma is common. With widespread use of magnetic resonance imaging, presymptomatic cases are being diagnosed and it is difficult to be certain about the true incidence of this disorder. Despite extensive investigations, the cause of bleeding is often not apparent. An intraspinal fluid-filled collection is a common accompaniment and may be the likely bleeding source. An early diagnosis and prompt intervention directed at removal of the bleeding source may prevent progression. This review discusses the role of multimodality imaging in evaluation of superficial siderosis and the therapeutic implications of identified associations.

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Role of dynamic CT myelography in identifying the etiology of superficial siderosis

Abstract: The authors report three cases of superficial siderosis with a fluid-filled spinal canal cavity communicating with the subarachnoid space. The site of communication was identified with dynamic CT myelography and the defect was surgically repaired.

Cited by 46 publications

References 10 publications

Neuroimaging in Superficial Siderosis: An In-Depth Look

Neuroimaging in Superficial Siderosis: An In-Depth Look

Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes

Superficial Siderosis

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