File:Cervical dural CSF leak on MRI and CT treated by blood patch (Radiopaedia 49748-54996 B 58).png

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Summary:

Description
  • Radiopaedia case ID: 49748
  • Image ID: 26779235
  • Image stack position: 58/117
  • Plane projection: Axial
  • Aux modality: CT post myelography
  • Study description: CT myelography demonstrating cervical CSF leak
  • Study findings: CT post myelogram confirms an extradural collection of contrast enhanced cerebrospinal fluid and suggests that the location of the leak into the epidural space lies dorsally at the height of C1/2. It is critical to recognize that contrast at this level is sometimes a false localizing sign as contrast ascends the in epidural space to the C1/2 level. Nonetheless, given that the contrast is most concentrated at this level, and little contrast is seen elsewhere in the epidural space, the cervical dural leak is treated by a CT-guided blood patch as demonstrated above.
  • Modality: CT
  • System: Spine
  • Findings: There is an extensive extradural fluid collection separating the dura from the bony spinal canal (curtain sign). The extradural fluid collection shows a T2 hyperintense signal compared to CSF (which shows a slightly lower signal due to flow/pulsation artifacts). The fluid collection shows a T1 hyperintense signal to CSF, probably due to proteinaceous content. The differential diagnosis of an epidural hemorrhage is excluded by a sagittal haemosensitive sequence which shows no blood products. We therefore suspect a spontaneous cerebrospinal fluid leak (CSF leak) with intracranial hypotension as a cause for the patients postural symptoms. The cranial T1 C+ sequence demonstrates diffuse smooth enhancing pachymeningeal thickening as well as the venous distension sign (rounding of the dominant dural venous sinus in sagittal imaging) fortifying the diagnosis of intracranial hypotension.
Date Published: 3rd Dec 2016
Source https://radiopaedia.org/cases/cervical-dural-csf-leak-on-mri-and-ct-treated-by-blood-patch
Author Yves Leonard Voss
Permission
(Permission-reusing-text)		 http://creativecommons.org/licenses/by-nc-sa/3.0/

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