Radioisotope cisternography: a potentially useful tool for headache diagnosis in patients with an IDD pump.
BACKGROUND
Spontaneous intracranial hypotension (SIH) and related headache after intrathecal pump implantation is a possibility. Knowing the exact location of the cerebrospinal fluid (CSF) leak is mandatory for managing with interventional therapies.


OBJECTIVE
Radioisotope cisternography (RICG) is a common procedure in nuclear medicine and may be used as an additional procedure in the differential diagnosis of headaches due to intracranial liquor hypotension syndrome caused by microleakage of CSF.


METHODS
We report an imaging case of complex chronic headache in a patient with an implanted drug delivery pump. The symptomatology of the patient was considered typical of spontaneous intracranial hypotension (SIH). Therefore, the initial suspicion was the loss of CSF due to the implanted pump catheter. The negativity of the routine headache test can exclude any leakage of CSF at the site of catheter insertion.


METHODS
Anesthesia, Critical Care, and Multidisciplinary Pain Management Department, General University General Hospital, Valencia, Spain.


RESULTS
Many patients are treated with implanted intrathecal infusion systems. In these patients, any neurological symptoms are readily attributed to the invasive neuroaxial system, especially severe cephalalgia. RICG was helpful in this particular case to make a diagnosis of exclusion of the diagnosis of SIH due to CSF leakage.


CONCLUSIONS
RICG may be considered as an additional diagnostic technique in patients with chronic pain and implanted spinal infusion devices for whom standard detection procedures have been exhausted.
Anesthesia, Critical Care, and Multidisciplinary Pain Management Department , General University Hospital, Valencia, Spain.
Jose
J
De Andres
Miguel J
MJ
Esparza
Jose
J
Ferrer-Rebolleda
Ascension
A
Castillo-Ruiz
Vincent Luis
VL
Villaneuva-Perez
D000328:Adult; D003947:Diagnostic Techniques, Radioisotope; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D019585:Intracranial Hypotension / Q000628:therapy; D008279:Magnetic Resonance Imaging; D011868:Radioisotopes; D013353:Subdural Effusion
D011868:Radioisotopes