Intracranial hypotension due to leakage of cerebrospinal fluid: could myelography be a therapeutic option?
Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid leakage. We report of a 29-year-old woman with typical symptoms in whom initial cranial MRI and CT were normal . A clinical diagnosis of SIH, but the symptoms did not resolve with conservative therapy or a lumbar epidural blood patch. Repeat MRI revealed (indirect) findings consistent with SIH but failed to directly demonstrate a cerebrospinal fluid fistula. Subsequent CT myelography revealed leakage of contrast medium into the epidural space bilaterally along the nerve roots at C3-7. Following the myelography the patient reported dramatic clinical improvement with complete resolution of symptoms. The adhesive quality of the myelographic contrast medium might have precipitated closure of the meningeal tears. Myelography may be not only of diagnostic value but also therapeutic in SIH.
Jeyrani
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R
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany. Jeyrani@web.de
Paul
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A
Doerfler
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Egelhof
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T
D000328:Adult; D003287:Contrast Media; D004824:Epidural Space / Q000000981:diagnostic imaging; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019585:Intracranial Hypotension / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008578:Meninges / Q000000981:diagnostic imaging; D009192:Myelography; D013353:Subdural Effusion / Q000150:complications*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media