Headaches and Spinal Fluid Leaks – An Emerging Problem

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The Mayo Clinic has published an interesting overview of CSF leaks in its September 2017 edition of the Mayo Clinic Health Letter, entitled ‘Headaches and Spinal Fluid Leaks – An Emerging Problem’.

“You’ve had headaches for years. You usually start the day fine, but by lunchtime, the pressure-like pain has begun and is growing in intensity. You’ve sought out plenty of treatment options, but nothing has truly helped. At this point, you’re trying to live with the pain as best you can by taking medications and reducing stress.

CSF Leak Association - Mayo Clinic Newsletter Sept 2017Headaches come in a variety of types — such as migraine, tension or cluster headaches — with a variety of characteristics. A lesser known cause of headache pain occurs with low levels of cerebrospinal fluid — a fluid that surrounds, cushions and protects the brain and spinal cord. Low fluid levels can be caused by a temporary leak that occurs when the membrane holding the fluid (dura) is punctured, such as after a lumbar puncture, during surgery or with an epidural injection to numb part of the body.

But cerebrospinal fluid (CSF) leaks also can occur spontaneously, typically along the spinal column, and aren’t always temporary…”

You can download a copy of the article and read the full text by clicking below:

Mayo Clinic Health Letter - Vol.35 No.9 (Sept 2017)

Upright Headache? Think CSF Leak!

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We’re thrilled to announce the publication of our latest infographic: Upright Headache? Think CSF Leak!

Upright Headache Think CSF Leak (PNG)The publication, produced in consultation with NHS neurologists Dr Simon Ellis and Dr Manjit Matharu, is designed to be printed off at both A3 and A4 size; it is ideal for use as a leaflet or poster, which can easily be passed on to friends and family, or given to your GP or other healthcare provider to display in their surgery or office.

Printed copies will be included in our members’ welcome pack from late June 2017 onward. You can download the infographic in PDF format for printing at home by clicking here.

Cerebrospinal Fluid Leaks: An Overview

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We are delighted to announce the publication of Cerebrospinal Fluid Leaks: An Overview, the latest edition to our popular factsheet series. It is free to download from our website.

This new leaflet provides a valuable overview of cerebrospinal fluid (CSF) csf-leak-association-factsheet-series-advert-csf-leaks-an-overviewleaks, both cranial and spinal, and touches upon key signs and symptoms, diagnostic techniques and treatment options.

It has been produced in consultation with two UK neurologists working in the NHS: Dr Simon Ellis, a consultant neurologist at Royal Stoke University Hospital, and Dr Manjit Matharu, a consultant neurologist at the National Hospital for Neurology and Neurosurgery.

Cerebrospinal Fluid Leaks: An Overview is a must-read for both diagnosed sufferers and those who suspect that they may be suffering from a CSF leak. It is ideal for inclusion in leaflet displays or handing out as part of an awareness-raising event.

The leaflet also provides useful information for GPs, doctors working in emergency medicine, paramedics and other healthcare professionals who may not routinely encounter CSF leaks in their work, but nonetheless need to know what to look out for and how to treat them.

Download the leaflet here: Cerebrospinal Fluid Leaks - An Overview

Measuring Opening Pressure on Lumbar Puncture

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CSF Leak Association Factsheet Series Advert - Opening Pressure on Lumbar Puncture

Measuring lumbar puncture opening pressure is common practice during CSF leak and spontaneous intracranial hypertension diagnosis.

Many confirmed or potential CSF leak sufferers often query how pressure is measured, the differences between opening pressure and intracranial pressure recording, and what ranges constitute normal, low and high pressure.

Our new factsheet explores the key ins/outs of measuring opening pressure by lumbar puncture and provides details on the common pressure ranges in tabulated form. Also covered are the basics of CSF production and absorption.

The importance of using non-cutting needles for lumbar puncture procedures, in order to reduce the risk of post-dural puncture headache and persistent CSF leak, is also highlighted.

Download the factsheet here: Measuring Opening Pressure & Intracranial Pressure

New CSF Leak Journal Articles

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We’ve added three additional journal articles to our downloads section.

Two articles about the use of gadolinium in CSF Leak detection:

One review paper by Dr Wouter Schievink of Cedars-Sinai Hospital, California:

CSF Leak Questions Answered by Dr Schievink

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We’re pleased to announce that with the kind permission of the CSFleak.org Forum, we are able to publish a recent Questions and Answers session with leading CSF leak expert, Dr Wouter Schievink. The questions were posted by members of the CSFleak.org forum during January 2014 and answers were provided on 4 April 2014. We are deeply grateful to the administrators of the forum for arranging and managing the Q&A session and for making the information available.

Dr Schievink is one of the world’s foremost experts on CSF leaks and Spontaneous Hypertension. Originally from The Netherlands, but now practicing Cedars-Sinai Hospital in California, he has conducted a number of studies into the diagnosis and treatment of CSF leaks and many specialists in the UK base their approach on his work.

This valuable information sheds light onto many of the questions and issues faced by leakers across the UK and Ireland. Dr Schievink’s advice will also be of relevance to GPs and other medical professionals dealing with patients presenting with persistent daily headaches and other symptoms of intracranial hypotension.

You can view the Q&As online by clicking here or download them by clicking here.

New Factsheet – What is a CSF Leak?

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We’re pleased to announce the publication of the first in a series of CSFleak.info factsheets – What is a CSF Leak? – which can be downloaded via our downloads section or by clicking on the button below.

Our factsheets provide easy access to key facts and information; they are printable and can be taken with you when you meet with your GP. They are provided in good faith and following careful research, however they cannot be guaranteed error-free and are not a substitute for professional healthcare advice.

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

The Value of Changing Position in the Detection of CSF Leakage

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ABSTRACT: Radionuclide Cisternography (RNC) is of potential value in pointing out the sites of cerebrospinal fluid (CSF) leakage in patients with spontaneous intracranial hypotension (SIH). In the current report, we present two patients who underwent RNC for suspected CSF leakage. Both patients underwent magnetic resonance imaging (MRI) and RNC for evaluation. We describe a simple method to increase the detection ability of RNC for CSF leakage in patients with SIH.