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Spontaneous C1-2 CSF Leak Treated with High Cervical Epidural Blood Patch

Published online by Cambridge University Press:  02 December 2014

Philip WH Peng  and
Richard Farb
Philip WH Peng
Affiliation:
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
Richard Farb
Affiliation:
Department of Radiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Spontaneous intracranial hypotension (SIH) is a condition caused by spontaneous spinal cerebrospinal fluid (CSF) leaks. Clinically, it is characterized by orthostatic headache and may respond well to epidural blood patch. Other neurological presentations of SIH include diplopia, memory loss, hearing deficits, Parkinsonism, ataxia, obtundation and even coma.

Magnetic resonance imaging (MRI) is crucial in the diagnosis of this condition. Typical radiological features include diffuse pachymeningeal enhancement, descent of the cerebellar tonsil, a decrease in the size of prepontine and perichiasmatic cisterns, and subdural fluid collections. However, radiological imaging such as radionuclide cisternography or spinal MRI are not reliable in detecting the site of leakage. Myelography with iodinated contrast followed by thin-cut computed tomography (CT) or MRI of the entire spine has been shown as the technique of choice in defining the location of the CSF leak.

Type
Peer Reviewed Letter
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 1 , March 2008 , pp. 102 - 105
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Schievink, WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006; 295(19):2286–96.CrossRefGoogle ScholarPubMed
2. Berroir, S, Loisel, B, Ducros, A, Boukobza, M, Tzourio, C, Valade, D, et al. Early epidural blood patch in spontaneous intracranial hypotension. Neurology. 2004; 63(10):1950–1.CrossRefGoogle ScholarPubMed
3. Mokri, B. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia-evolution of a concept. Mayo Clin Proc. 1999; 74(11):1113–23.CrossRefGoogle ScholarPubMed
4. Benamor, M, Tainturier, C, Graveleau, P, Pierot, L. Radionuclide cisternography in spontaneous intracranial hypotension. Clin Nucl Med. 1998; 23(3):150–1.CrossRefGoogle ScholarPubMed
5. Matsumura, A, Anno, I, Kimura, H, Ishikawa, E, Nose, T. Diagnosis of spontaneous intracranial hypotension by using magnetic resonance myelography. J Neurosurg. 2000; 92(5):873–6.CrossRefGoogle ScholarPubMed
6. Chiapparini, L, Farina, L, D’Incerti, L, Erbetta, A, Pareyson, D, Carriero, MR, et al. Spinal radiological findings in nine patients with spontaneous intracranial hypotension. Neuroradiology. 2002; 44(2):143–50.CrossRefGoogle ScholarPubMed
7. Cousins, MJ, Brazier, D, Cook, R. Intracranial hypotension caused by cervical cerebrospinal fluid leak: treatment with epidural blood patch. Anesth Analg. 2004; 98(6):1794–7.CrossRefGoogle ScholarPubMed
8. Waguri, N, Tomita, M, Hayatsu, K, Okamoto, K, Shimoji, K. Epidural blood patch for treatment of spontaneous intracranial hypotension. Acta Anaesthesiol Scand. 2002; 46(6):747–50.CrossRefGoogle ScholarPubMed
9. Usui, T, Saito, S, Goto, F. Spontaneous intracranial hypotension treated with a cervical epidural blood patch. Eur J Anaesthesiol. 2003; 20(6): 500–2.CrossRefGoogle ScholarPubMed
10. Ong, B, Fong, W. Spontaneous cervical spine cerebrospinal fluid leak with resultant intracranial hypotension. Clin Nucl Med. 2003; 28(11):916–9.CrossRefGoogle ScholarPubMed
11. Inamasu, J, Nakamura, Y, Orii, M, Saito, R, Kuroshima, Y, Mayanagi, K, et al. Treatment of spontaneous intracranial hypotension secondary to C-2 meningeal cyst by surgical packing-case report. Neurol Med Chir. 2004; 44(6):326–30.CrossRefGoogle ScholarPubMed
12. Rai, A, Rosen, C, Carpenter, J, Miele, V. Epidural blood patch at C2: diagnosis and treatment of spontaneous intracranial hypotension. AJNR Am J. Neuroradiol. 2006; 26(10):2663–6.Google Scholar
13. Tali, ET, Ercan, N, Krumina, G, Rudwan, M, Mironov, A, Zeng, QY, et al. Intrathecal Gadolinium (Gadopentetate Dimeglumine) enhanced magnetic resonance myelography and cisternography. Results of a multicenter study. Invest Radiol. 2002; 37(3): 152–9.CrossRefGoogle ScholarPubMed
14. Jinkins, JR, Rudwan, M, Krumina, G, Tali, ET. Intrathecal Gadolinium enhanced MR Cisternography in the evaluation of clinically suspected cerebrospinal fluid rhinorrhea in humans: early experience. Radiology. 2002; 222(2):555–9.CrossRefGoogle ScholarPubMed
15. Chung, SJ, Kim, JS, Lee, MC. Syndrome of cerebral spinal fluid hypovolemia. Clinical and imaging features and outcome. Neurology. 2000; 55(9):1321–7.CrossRefGoogle ScholarPubMed
16. Diaz, JH. Treatment outcomes in spontaneous intracranial hypotension: do epidural blood patches stop the leaks? Pain Practice. 2004; 4(4):295–302.CrossRefGoogle ScholarPubMed
17. Hogan, QH. Epidural anatomy examined by cryomicrotome section. Influence of age, vertebral level, and disease. Reg Anesth. 1996; 21(5):395–406.Google ScholarPubMed
18. Stojanovic, MP, Vu, TN, Caneris, O, Slezak, J, Cohen, SP, Sang, CN. The role of fluoroscopy in cervical epidural steroid injection. An analysis of contrast dispersal patterns. Spine. 2002; 27(5):509–14.CrossRefGoogle ScholarPubMed
19. Schievink, WI, Maya, MM, Tourje, J. False localizing sign of C1-2 cerebrospinal fluid leak in spontaneous intracranial hypotension. J Neurosurg. 2004; 100(6):639–44.CrossRefGoogle ScholarPubMed
20. Zeng, Q, Xiong, L., Jinkins, JR, Fan, Z, Liu, Z. Intrathecal gadolinium (gadopentetate dimeglumine)-enhanced MR myelography: a pilot study in human patients. Am J Radiol. 1999; 173(4): 1109–15.Google ScholarPubMed