Type:
Educational Exhibit
Keywords:
Fistula, Cerebrospinal fluid, Treatment effects, Myelography, Diagnostic procedure, MR, CT, Neuroradiology spine, Neuroradiology brain
Authors:
C. P. Fernandez Ruiz, D. H. Jiménez, E. Garcia Martinez, L. Navarro Vilar, C. Poyatos, F. Dominguez; Valencia/ES
DOI:
10.1594/ecr2013/C-1557
Background
Persistent headache by IH is a syndrome with serious neurological sequelae.
It is an important cause of headache in young and middle aged individuals but it is often misdiagnosis.
We retrospectively reviewed data,
medical history and imaging of five patients in our hospital,
3 men and 2 women,
age range between 27 and 54 years,
who were admitted for suspected intracranial hypotension by licuoral fistula between May 2007 and September 2011.
All patients underwent,
initial cranial CT without intravenous contrast enhancement (GE 64-detector rows) by disabling orthostatic headache.
Patients with suspecting HI,
were admitted and did underwent brain and spinal MRI (Philips 1.5 Tesla),
performing TSE sequences T1,
T2,
PD,
FLAIR and T1 with intravenous contrast enhancement (gadolinium).
When there were signs of licuoral fistula on MRI,
the study of patient was completed with mieloCT.
The puncture fluoroscopy-guided was performed in the lumbar region,
the pressure of CSF was measured and 6 cc was extracted for analysis when was possible; then until 10 cc of water-soluble iodinated contrast media (Optiray) was injected and the table of patient was tilted,
then when contrast media agent reaches cervical region,
allow visualize the spinal cord,
to determine the presence of contrast extravasation or presence of fistula and find their location.
We used the diagnostic criteria of HI by CSF fistula proposed by Schievink et al (AJNR May 2008),
which includes clinical and radiological criteria.
We considered two treatment options: the first,
recommending bed rest,
oral hydration abundant,
paracetamol and caffeine.