title: Delayed gadolinium enhancement in epidural space of the cervicothoracic spine in a patient with spontaneous intracranial hypotension.
abstract: Spontaneous intracranial hypotension (SIH) due to a spinal cerebrospinal fluid leak is a rare but increasing cause of postural headache. Its extravasated epidural fluid collection tends to be non-enhanced or mildly enhanced on enhanced magnetic resonance (MR) imaging. The mild enhancement of the epidural fluid in SIH is usually attributed to fenestrated neovascularization provoked by an inflammatory component, such as blood, of the fluid collection. In this report, we present a case of SIH with a prominent delayed enhancement of the spinal epidural fluid collection on MR imaging. Subsequent vertebral angiography revealed that this delayed enhancement was related to contrast extravasation from a torn anterior meningeal branch of the right vertebral artery. Therefore, we suggest that contrast extravasation from a torn meningeal vessel may be a possible cause of the enhancement in the spinal epidural fluid of SIH.
authors.affiliation: 2nd Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Hsu
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Long-Sun
authors.initials: LS
authors.lastname: Ro
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Wang
authors.forename: Yon-Cheong
authors.initials: YC
authors.lastname: Wong
mesh_terms: D002574:Cervical Vertebrae; D004824:Epidural Space; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D019585:Intracranial Hypotension / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013904:Thoracic Vertebrae
chemical_list: D005682:Gadolinium