Journal Article: Dynamic CT Myelography

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A Technique for Localizing High-Flow Spinal Cerebrospinal Fluid Leaks

We’ve added an interesting journal article on the use of dynamic CT Myelography in locating the site of a high-flow cerebrospinal fluid (CSF) leak. You can download the article by clicking here.

Summary

In some patients with spontaneous spinal CSF leaks, leaks are numerous or tears are so large that extrathecal myelographic contrast material is seen at multiple levels during CT, making identification of their source impossible. This study introduces a dynamic CT myelographic technique that provides high temporal and spatial resolution. In this technical note, we describe the utility of this technique in four patients with challenging high-flow spinal CSF leaks.

 

 

New Factsheet: Example Medical Report for CT Myelogram

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Our latest CSFleak.info factsheet comprises an example of a medical report for CT Myelography and epidural blood patch carried out at Duke University Hospital by Dr Linda Leithe-Gray.

The patient is a UK national who travelled to the United States for investigatory procedures not commonly available on the NHS , yet shown through research to return a comparably high level of success in locating the site of CSF leak in comparison to Radionuclide Cisternography and conventional MRI.

It is hoped that this report, which outlines the specific procedures used regularly and successfully at Duke University Hospital, may inform and support doctors in their diagnosis and treatment of CSF Leaks in the UK. Our thanks and gratitude goes to the patient for allowing us to publish this information for the benefit of others.

You can download the factsheet by clicking here.

Spinal Meningeal Diverticula in Spontaneous Intracranial Hypotension

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Authors: P.G. Kranza, S.S. Stinnettb, K.T. Huanga and L. Graya

Abstract

BACKGROUND AND PURPOSE: Spinal meningeal diverticula have been implicated in the pathogenesis of spontaneous intracranial hypotension and have been proposed as both diagnostic features of and therapeutic targets for the condition. We compared the prevalence and myelographic appearance of spinal diverticula in patients with SIH and healthy controls.

MATERIALS AND METHODS: Patients satisfying the ICHD-2 criteria for SIH were retrospectively identified. CT myelograms of 19 patients with SIH were compared with CT myelograms of 18 control patients. Images were reviewed by 2 blinded neuroradiologists. The prevalence, morphology (round versus multilobulated), size, and location (cervical, upper thoracic, lower thoracic, or lumbar) of spinal meningeal diverticula were analyzed.

RESULTS: There was no difference in the proportion of patients with diverticula in the SIH group compared with the control group (68% versus 44%, P = .14) or in the mean number of diverticula per patient (6.3 versus 2.2, P = .099). No difference was seen in the morphology (P = .95) or size (P = .71) of diverticula between groups. There was a difference between groups that just reached statistical significance (P = .050) in the location of the diverticula along the spinal axis, but substantial overlap was seen between groups for all spinal locations.

CONCLUSIONS: Despite the well-established association between spinal meningeal diverticula and SIH, we found no difference in the prevalence  or myelographic appearance of diverticula in patients with SIH compared with controls. Further investigation into the role of diverticula in the diagnosis and treatment of SIH is necessary.

© 2013 by American Journal of Neuroradiology

Read more here: http://www.ajnr.org/content/34/6/1284.abstract

Headache Journal: Spontaneous Cerebrospinal Fluid (CSF) Leaks

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Spontaneous cerebrospinal fluid (CSF) leaks typically present with orthostatic headaches. Less commonly, spontaneous CSF leaks can present with other headache types. Nausea, vomiting, hearing disturbances, diplopia, back pain, and dizziness are not uncommon associated symptoms. Although the exact cause of CSF leaks often remains uncertain, some patients may be predisposed due to disorders of connective tissue or spinal meningeal anomalies.

When a spontaneous CSF leak is suspected, head MRI with contrast is ordinarily the first study to obtain. Common abnormalities seen include diffuse dural enhancement, subdural fluid collections, engorged cerebral venous sinuses, and cerebral descent. Important to know is the fact that despite typical clinical features, head MRI may occasionally be unremarkable. In such situations, ancillary studies may help answer whether a CSF leak is present. Radioisotope cisternography and spine MRI are helpful tools in such occurrences. Presently, CT-myelography remains the most reliable test to find the exact spinal CSF leak site. Often, however, the exact CSF leak site is not found.

Read the full article here: http://www.headachejournal.org/view/0/CSFLeaks.html

Health: How spinal condition lead to crippling headaches

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Struggling off the bus in agony, Deborah Ogg barely knew what was happening.

She had never suffered from headaches, but suddenly she was in such excruciating pain that she had to lie down in the street, utterly overwhelmed.

Her worried partner Peter looked on, helpless, and even the taxi driver he summoned offered to take them straight to hospital. But Deborah, 40, hating to make a fuss, insisted on going home to bed.

“I felt like somebody had hit me over the head with an iron bar,” she recalls, “It was massive pain.”

The pharmacist recommended migraine pills, but they didn’t help. “I tried getting up to go to the toilet but as soon as I got up the pain was even worse and I was on my knees, I just crumpled,” she says.

It was April 1 last year, and the start of a long and painful journey with what she eventually discovered was a rare condition called cerebrospinal fluid (CSF) leak.

Affecting around one person in 50,000, it occurs when the fluid, which cushions the brain and spine, leaks out through a hole in its protective sac. This results in a drop in pressure, so that the brain can no longer float in fluid.

The brain cannot feel pain, but the resulting “brain sag” pulls on tendons and muscles across the head, causing extreme pain, which is slightly relieved when sufferers lie down.

It is most common after epidurals or spinal operations, but in some cases, such as Deborah’s, occurs spontaneously, which makes treatment harder, because the location of the leak is not known.

Read the full article here: http://www.edinburghnews.scotsman.com/news/health/health-how-spinal-condition-lead-to-crippling-headaches-1-2150059