title: Radionuclide cisternography in spontaneous intracranial hypotension with simultaneous leaks at the cervicothoracic and lumbar levels.
abstract: This case report clearly illustrates defined simultaneous cerebrospinal fluid leaks at the cervicothoracic and upper lumbar areas. A 53-year-old woman without a remarkable medical history was hospitalized for sudden onset of severe headache. The headache lasted more than 1 week and standing or sitting positions exaggerated the symptoms, although it was relieved when the patient was recumbent. Radionuclide cisternography was performed using 150 MBq (4 mCi) Tc-99m DTPA. It revealed two cerebrospinal fluid leaks from the cervicothoracic junction bilaterally and the left side of the upper lumbar area. Epidural blood patching was tried at the lumbar level (L1-L2) and showed only a transient effect. A second trial of this method at the level of C7-T1 performed 2 days later resulted in immediate improvement of the symptoms without recurrence. The simultaneous cerebrospinal fluid leaks were detected successfully with radionuclide cisternography using Tc-99m DTPA, which provided a useful guideline for treatment despite the limitations of delayed scanning.
authors.affiliation: Department of Diagnostic Radiology, Research Institute of Radiologic Science, Yonsei University, College of Medicine, Seoul, Korea. tjjeon@yumc.yonsei.ac.kr
authors.forename: T J
authors.initials: TJ
authors.lastname: Jeon
authors.forename: J D
authors.initials: JD
authors.lastname: Lee
authors.forename: B I
authors.initials: BI
authors.lastname: Lee
authors.forename: D I
authors.initials: DI
authors.lastname: Kim
authors.forename: H S
authors.initials: HS
authors.lastname: Yoo
mesh_terms: D017217:Blood Patch, Epidural; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D002946:Cisterna Magna / Q000000981:diagnostic imaging*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D019585:Intracranial Hypotension / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging* / Q000628:therapy; D008161:Lumbosacral Region / Q000000981:diagnostic imaging; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate; D013909:Thorax / Q000000981:diagnostic imaging; D014012:Tinnitus / Q000209:etiology
chemical_list: D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate