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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

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