False localizing sign of C1–2 cerebrospinal fluid leak in spontaneous intracranial hypotension

Abstract

A retrospinal fluid collection at the C1-2 level does not necessarily indicate the site of the CSF leak in patients with spontaneous intracranial hypotension. This is an important consideration in the treatment of these patients because therapy may be inadvertently directed at this site.

Diagnostic Value of Spinal MR Imaging in Spontaneous Intracranial Hypotension Syndrome

“…Abnormal intensity around the nerve root sleeve may indicate the precise CSF leakage site; however, a false localizing sign at the C1-2 level is also pointed out. 28 The low sensitivity of this finding shown in our study suggests less value of this finding for the diagnosis of SIH.…”

The Role of MR Myelography with Intrathecal Gadolinium in Localization of Spinal CSF Leaks in Patients with Spontaneous Intracranial Hypotension

“…However, no leaks were identified at the C1-C2 level, which has been reported by others as false localizing due to artifacts. 17 Artifacts at the cervicothoracic junction due to poor fat saturation were seen in all 41 patients (100%). 18 Precontrast T1 fat-saturated imaging was used in 34 of 41 patients to aid in the differentiation of artifacts and true leaks.…”

Avoiding the drill: Intracranial hypotension presenting with subdural haematoma

“…5 Spinal imaging including CT myelography may localise the CSF leak but accumulation of CSF in the soft tissues behind C1-C2 is often seen, whatever the location of the dural defect. 6 This finding may reflect the wide range of rotation and deficient ligamentum flavum at C1/C2, which favour escape of CSF from the epidural space at this level.…”