Spontaneous Cerebrospinal Fluid Leak With Venous Engorgement Mimicking a Contrast-Enhancing Cervical Mass

Herwerth, Marina; Prothmann, Sascha; Kreiser, Kornelia; Hemmer, Bernhard; Ploner, Markus

doi:10.1001/jamaneurol.2016.0277

Cited by 2 publications

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“…In patients with SIH, there may be increased CSF production in an attempt to compensate for a low CSF pressure state, as well as decreased venous pressure/venous dilation as can sometimes be seen on imaging studies. 9 These could potentially increase the rate of CSF absorption and therefore intrathecal contrast absorption in patients with SIH. Although this phenomenon could potentially contribute to early renal contrast in patients with SIH, it would not explain why early renal contrast is seen more commonly in CVF than in a dural CSF leak, and this seems more likely due to contrast directly entering a vein rather than the epidural space in a CVF.…”

Section: Discussionmentioning

confidence: 99%

Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension

Kinsman

Verdoorn

Luetmer

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The significance of renal contrast on CT myelography is uncertain. This project examined different patient populations undergoing CT myelography for the presence of renal contrast to determine whether this finding is of diagnostic value in spontaneous intracranial hypotension. MATERIALS AND METHODS: Four groups of patients were analyzed for renal contrast on CT myelography. The control group underwent CT myelography for reasons other than spontaneous intracranial hypotension (n ϭ 47). Patients in study group 1 had spontaneous intracranial hypotension but CT myelography negative for dural CSF leak and CSF venous fistula (n ϭ 83). Patients in study group 2 had spontaneous intracranial hypotension and CT myelography positive for dural CSF leak (n ϭ 44). Patients in study group 3 had spontaneous intracranial hypotension and CT myelography suggestive of CSF venous fistula due to a hyperdense paraspinal vein (n ϭ 17, eleven surgically confirmed). RESULTS: Renal contrast was present on the initial CT myelography in 0/47 patients in the control group, 10/83 patients in group one, 1/44 patients in group 2, and 7/17 patients in group 3. Renal contrast on initial CT myelography in patients with suspected or surgically confirmed CSF venous fistula was significantly more likely than in patients with a dural CSF leak (P ϭ .0003). CONCLUSIONS: Renal contrast on initial CT myelography was seen only in patients with spontaneous intracranial hypotension. This was more common in confirmed/suspected CSF venous fistulas compared with dural leaks. Early renal contrast in patients with spontaneous intracranial hypotension should prompt scrutiny for a hyperdense paraspinal vein, and, if none is found, potentially advanced diagnostic studies.

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Section: Discussionmentioning

confidence: 99%