Spontaneous intracranial hypotension: MRI and radionuclide cisternography findings.

Spelle, L.; Boulin, A.; Piérot, Laurent; Graveleau, P; Tainturier, C.

doi:10.1136/jnnp.62.3.291

Cited by 19 publications

(19 citation statements)

References 8 publications

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“…10,17) MR imaging and MR myelography before and after RI cisternography on 10 patients with orthostatic headache found that 5 had lumbosacral CSF leaks after the lumbar puncture, whereas none showed CSF leaks before the puncture. 12) In 4 of the 5 patients with CSF leaks, RI cisternography showed lumbosacral CSF leaks.…”

Section: Discussionmentioning

confidence: 99%

“…6) Both these disorders are thought to be caused by spontaneous CSF leakage, 16) so the presence of a CSF leak is important to prove if a treatment with an epidural blood patch is planned. 5,14) Radioisotope (RI) cisternography, 5,17) MR myelography, 19,21,23) spinal MR imaging, 4,11,22) computed tomography (CT) myelography, 14,15) and intrathecal gadolinium-enhanced MR myelography have been reported to show spinal CSF leaks. 1,20) This study proposes the occurrence of floating dural sac sign, which is observed as a hyperintense band or rim around the spinal dural sac on axial T 2 -weighted images (Fig.…”

Section: Introductionmentioning

confidence: 99%

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Floating Dural Sac Sign is a Sensitive Magnetic Resonance Imaging Finding of Spinal Cerebrospinal Fluid Leakage

Hosoya

Hatazawa

Sato

et al. 2013

Neurol. Med. Chir.(Tokyo)

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We would like to propose floating dural sac sign, which is observed as a hyperintense band or rim around the spinal dural sac on axial T 2 -weighted images, as a sensitive sign to identify cerebrospinal fluid (CSF) leakage. One hundred patients with orthostatic headache were prospectively registered in 11 hospitals. These patients were examined by brain magnetic resonance (MR) imaging (n ＝ 89), radioisotope cisternography (n ＝ 89), MR myelography (n ＝ 86), axial T 2 -weighted imaging of the spine (n ＝ 70), and computed tomography myelography (n ＝ 2). In this study, we separately evaluated the imaging findings of intracranial hypotension and spinal CSF leakage. Among 100 patients, 16 patients were diagnosed as having spinal CSF leaks. Of 70 patients examined with axial T 2 -weighted imaging, 14 patients were diagnosed with spinal CSF leaks, and floating dural sac sign was observed in 17 patients, 13 patients with spinal CSF leaks and 4 without CSF leaks (sensitivity 92.9%, specificity 92.9%). Of 86 patients examined by MR myelography, extradural fluid was observed in only 3 patients (sensitivity 21.4%, specificity 100%). The floating dural sac sign was a sensitive sign that can be used to identify CSF leakage. Spinal axial T 2 -weighted imaging might be a good screening method for spinal CSF leakage that can help to avoid the need for lumbar puncture.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Floating Dural Sac Sign is a Sensitive Magnetic Resonance Imaging Finding of Spinal Cerebrospinal Fluid Leakage

Hosoya

Hatazawa

Sato

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…It may be associated with nausea, vomiting, neck stiffness, horizontal diplopia, blurring of vision, photophobia, field defects, vertigo, tinnitus, dysgeusia, unilateral facial numbness, and weakness. [3567] Conservative methods like bed rest are the first line treatment. [8] If not effective, interventional methods like autologous epidural blood patch are used.…”

Section: Discussionmentioning

confidence: 99%

Radionuclide cisternography: A prudent investigation in diagnosing spontaneous intracranial hypotension

et al. 2013

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Spontaneous intracranial hypotension (SIH) is a cause of new persistent headache, which disappears on recumbence and reappears in sitting/standing position (orthostatic headache). We present a case of orthostatic headache, where the patient was suspected to have SIH and was subjected to radionuclide cisternography (RNC) using 99m Technetium Diethylenetriaminepenta acetic acid for confirmation of diagnosis. After due consent from the patient, the radiotracer was injected intra-thecally and serial images were acquired until 24 h. The direct and indirect evidences of Cerebrospinal fluid (CSF) leakage, which were revealed in our study, provided objective evidence to the clinical diagnosis. RNC is an important investigation in diagnosing SIH and also identifying the site of CSF leak, which may aid the management.

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“…8). 13,40,50,62,63,70,71,79 In most cases, this study will show early accumulation of tracer in the kidneys and bladder, slow ascent along the spinal axis, and less activity than expected over the cerebral convexities. These findings suggest unusually rapid uptake of tracer into the bloodstream through the extensive epidural venous plexus.…”

Section: Radionuclide Cisternographymentioning

confidence: 94%

“…In some patients, particularly those who have not received specific treatment for their CSF leak, considerable clinical improvement is shown over time whereas their MR-documented abnormalities persist. 8,79 In most patients, the pachymeningeal enhancement is the first abnormality that resolves, whereas the brain sagging may linger for a considerably longer time or show only partial improvement. 56,71 …”

Section: Cerebral Mr Imagingmentioning

confidence: 99%

Spontaneous spinal cerebrospinal fluid leaks: a review

Schievink¹

2000

FOC

137

148

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Spontaneous intracranial hypotension has become a well-recognized clinical entity, but it remains an uncommonly, and probably underdiagnosed, cause of headache; its estimated prevalence is only one in 50,000 individuals. The clinical spectrum of spontaneous intracranial hypotension is quite variable and includes headache, neck stiffness, cranial nerve dysfunction, radicular arm pain, and symptoms of diencephalic or hindbrain herniation. Leakage of the spinal cerebrospinal fluid (CSF) is the most common cause of spontaneous intracranial hypotension. A combination of an underlying weakness of the spinal meninges and a more or less trivial traumatic event is often found to cause this event in these patients. Typical magnetic resonance imaging findings include diffuse pachymeningeal enhancement, sub-dural fluid collections, and downward displacement of the brain, sometimes mimicking a Chiari I malformation. Opening pressure is often, but not always, low, and examination of CSF may reveal pleocytosis, an elevated protein count, and xanthochromia. The use of myelography computerized tomography scanning is the most reliable method for the accurate localization of the CSF leak. Most CSF leaks are found at the cervicothoracic junction or in the thoracic spine. The initial treatment of choice is a lumbar epidural blood patch, regardless of the location of the CSF leak. If the epidural blood patch fails, the blood patch procedure can be repeated at the lumbar level, or a blood patch can be directed at the exact site of the leak. Surgical repair of the CSF leak is safe and generally successful, although a distinct structural cause of the leak often is not found.

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Spontaneous intracranial hypotension: MRI and radionuclide cisternography findings.

Abstract: Group 2 (weak to moderate staining) 15-5 (6 7) (n = 22) 16-1 (9 4) (n = 13)There were no significant differences between groups (Student's t test).gliomas, but failed to show a correlation with cell proliferation. Nor was the occa-

Cited by 19 publications

References 8 publications

Floating Dural Sac Sign is a Sensitive Magnetic Resonance Imaging Finding of Spinal Cerebrospinal Fluid Leakage

Floating Dural Sac Sign is a Sensitive Magnetic Resonance Imaging Finding of Spinal Cerebrospinal Fluid Leakage

Radionuclide cisternography: A prudent investigation in diagnosing spontaneous intracranial hypotension

Spontaneous spinal cerebrospinal fluid leaks: a review

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