V Vijayakumar, M Anderson
mri, radionuclide cisternogram, spinal csf leak, trauma
V Vijayakumar, M Anderson. Demonstration Of Loculated Spinal CSF Leak By Radionuclide Cisternogram And MRI. The Internet Journal of Nuclear Medicine. 2004 Volume 2 Number 1.
Trauma is a common cause of spinal CSF leak. Other causes that are associated with spinal CSF leak include spinal injury due to fracture or stab wound, epidural anesthesia, lumbar puncture, spontaneous, bronchopleural fistula due to bronchogenic carcinoma. Traumatic CSF leaks are more common in the cervicothoracic and the thoracic spinal area. Spinal CSF leak can lead to infection, intracranial hypotension and headache. Radionuclide cisternogram plays an important role in the localization of spinal CSF leaks.
The patient is a 63-year-old male with H/o Cervical stenosis and radiculopathy underwent C3-C6 decompression and instrumentation. The patient developed postoperative spinal CSF leak which was surgically repaired. He presented with recurrent spinal CSF leak. An MRI and radionuclide cisternogram were obtained to localize the leak.
Radionuclide cisternogram is usually performed in confirming the diagnosis of normal pressure hydrocephalus and CSF otorrhea or rhinorrhea in basal skull fractures. However, it has been shown to be of great value as demonstrated in our case and complimentary to MRI in characterizing the spinal CSF leaks and defining exact location. Spinal trauma from several causes lead to spinal CSF leak (1,2,3,4,5,6). Some times CT myelography may falsely localize the site of leak which is causing spontaneous intracranial hypotension (6). Radionuclide cisternogram is helpful in those circumstances. Spinal CSF leaks are mostly self-limiting. Persistent leaks with symptoms and associated complications require surgical repair.
Vani Vijayakumar, MD Clinical Science Bldg, Rm 2.474 301 University Blvd. Galveston, TX 77555-0793 Tel: 409-772-8016 Fax: 409-747-2860 Email: firstname.lastname@example.org