title: Incidental findings of CSF leakage in patients without spontaneous intracranial hypotension and development of post-dural puncture headache.
abstract: OBJECTIVE
  To determine if nerve root sleeve diverticula or CSF leakage correlate with post-dural puncture headache (PDPH).
  
  
  METHODS
  A total of 781 lumbar and 408 cervical post-myelogram CTs were reviewed using a total diverticulum and leakage (TDL) score: 1, nerve root sleeve diverticulum not beyond the lateral vertebral body; 2, diverticulum beyond the lateral vertebral body; 3, periradicular contrast; 4, epidural contrast medium collection. Two scores at each level (left, right) were added for a total score. Results were correlated with post-procedure follow-up.
  
  
  RESULTS
  PDPH occurred in 22 (2.8 %) lumbar and 15 (3.7 %) cervical patients. Iodine concentration was not significantly different in lumbar (P = 0.14) or cervical (P = 0.85) patients with or without PDPH. Total scores correlated with PDPH after lumbar (P < 0.0001) and cervical (P < 0.0001) myelography. PDPH patients were younger (P = 0.002 lumbar, P = 0.0001 cervical) and more were female (P = 0.039 lumbar, P = 0.045 cervical). Using multiple regression, a lumbar epidural contrast collection or cervical diverticulum extending beyond the lateral vertebral body correlated with PDPH (P < 0.0001 and P = 0.03, respectively).
  
  
  CONCLUSIONS
  PDPH correlates with a higher TDL score. Lumbar epidural contrast medium collections and cervical diverticula extending beyond the lateral vertebral body margin are associated with PDPH.
  
  
  CONCLUSIONS
  • Elongated cervical nerve root sleeve diverticula are associated with post-dural puncture headaches. • Lumbar epidural contrast medium collections are associated with post-dural puncture headaches. • This information may help assess the risk of post-dural puncture headache.
authors.affiliation: Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, fakhrans@upmc.edu.
authors.forename: Saeed
authors.initials: S
authors.lastname: Fakhran
authors.forename: Stacy
authors.initials: S
authors.lastname: Palfey
authors.forename: Andrew
authors.initials: A
authors.lastname: Thomas
authors.forename: Samuel
authors.initials: S
authors.lastname: Schwarz
authors.forename: Lea
authors.initials: L
authors.lastname: Alhilali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002555:Cerebrospinal Fluid / Q000000981:diagnostic imaging*; D004240:Diverticulum / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009192:Myelography; D018579:Patient Selection; D051299:Post-Dural Puncture Headache / Q000209:etiology*; D011843:Radiculopathy / Q000150:complications* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D055815:Young Adult