1/55. Posttraumatic subdural hygroma: CT findings and differential diagnosis.Subdural hygroma is a cerebrospinal fluid accumulation in the subdural space. It is an epiphenomenon of head injury. CT is the preferred diagnostic imaging modality. Differential diagnosis has to be made with chronic subdural hematoma, and atrophy with enlargement of the subarachnoid space. As time goes by, subdural hygroma either resolves, or it becomes a chronic subdural hematoma. Neurosurgical evacuation is only required when mass effect creates neurologic symptoms.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/55. diagnosis of spontaneous intracranial hypotension by using magnetic resonance myelography. Case report.The authors describe a case of spontaneous intracranial hypotension in which the leakage site was determined by using magnetic resonance (MR) myelography. This technique demonstrated the route of cerebrospinal fluid (CSF) leakage, whereas other methods failed to show direct evidence of leakage. Magnetic resonance myelography is a noninvasive method that is highly sensitive in detecting CSF leakage. This is the first report in which a site of CSF leakage was detected using MR myelography.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
3/55. Pump-regulated cerebrospinal fluid drainage.The drainage of cerebrospinal fluid (CSF) from the lumbar subarachnoid space is an effective technique for the treatment of CSF fistula and control of intracranial pressure in children and adults. The use of the lumbar drain poses unique challenges, however, in the pediatric population. We present a safe and effective method of pump-controlled lumbar subarachnoid drainage. This technique allows accurate titration of CSF removal while providing a closed system which is not sensitive to position changes or patient activity. Four case histories are reviewed.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
4/55. Hemorrhagic subdural effusion complicating an endoscopic III ventriculostomy.subdural effusion, a common postoperative complication of extracranial shunting for hydrocephalus, is usually caused by excessive drainage of cerebrospinal fluid. subdural effusion is thought to occur less frequently after a neuroendoscopic III ventriculostomy, and no reported cases have been symptomatic. We encountered a symptomatic subdural effusion with a component of hemorrhage 5 days after the latter procedure was performed to treat massive hydrocephalus in a 2-year-old boy.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
5/55. Multi-level disruption of the spinal nerve root sleeves in spontaneous spinal cerebrospinal fluid leakage--two case reports.A 37-year-old male and an 18-year-old male presented with spontaneous spinal cerebrospinal fluid (CSF) leakage from multiple nerve root sleeves. Both patients suffered abrupt onset of intense headache followed by nausea, dizziness, and one patient with and one without positional headache. Radioisotope spinal cisternography of both patients revealed that the CSF leaks were not localized in a special zone but distributed to multiple spinal nerve root sleeves. Magnetic resonance (MR) myelography suggested that the spinal CSF column was fully expanded to the root sleeves. The extraspinal nerve bundles demonstrated numerous high intensity spots. Both patients were treated conservatively, and their symptoms resolved within one month. Repeat radioisotope cisternography and MR myelography confirmed the spine was normal after recovery. We suggest that spreading disruption of the arachnoid membrane occurs at the nerve root sleeves due to CSF overflow into the spinal canal.- - - - - - - - - - ranking = 19keywords = spinal (Clic here for more details about this article) |
6/55. Transoral transclival approach for intradural lesions using a protective bone baffle to block cerebrospinal fluid pulse energy--two case reports.The transoral transclival approach for the treatment of intradural lesions of the clivus is often associated with serious complications such as cerebrospinal fluid (CSF) leakage and meningitis. CSF pulse energy may be the most significant factor in CSF leakage and meningitis, but a bone baffle can block such CSF pulse energy. A 64-year-old female presented with sudden onset of severe headache. She had subarachnoidal hemorrhage due to a rupture of the vertebral-posterior inferior cerebellar artery aneurysm. A 66-year-old female complaining of occipitalgia and numbness of the extremities had a foramen magnum meningioma. Both patients were treated via the transoral transclival route with a protective bone baffle, obtained from the iliac bone, securely fixed in the bone window to protect the repaired dura from injury by CSF pulse energy. Neither patient showed CSF leakage or meningitis, and the period of continuous lumbar CSF drainage was only 7 days. The transoral transclival approach with a bone baffle is still very effective in selected cases.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
7/55. cerebrospinal fluid leak treated by aspiration and epidural blood patch under computed tomography guidance.BACKGROUND AND OBJECTIVES: cerebrospinal fluid (CSF) leakage secondary to surgery of the spine is usually treated by drainage of CSF through a subarachnoid catheter or surgical repair of the dural tear. We present 2 cases in which the pseudomeningocele was treated by aspiration of the leaked CSF and blood patch under computed tomography (CT) guidance. CASE REPORT: Two patients had headache after spine surgery. physical examination showed a bulging accumulation of fluid at the laminectomy site. Aspiration of the fluid followed by injection of the patients' blood was performed aseptically under CT guidance. The patients had resolution of their headache, and follow-up showed no recurrence of the CSF leak. CONCLUSIONS: CSF leak secondary to a surgical tear of the dura can be successfully treated by aspiration of the fluid followed by injection of the patient's blood. CT guidance is recommended to assess the extent of the CSF leakage, determine the degree of evacuation of the leaked CSF, and to confirm the injection of the blood into the epidural space and the space created by the pseudomeningocele.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
8/55. Bilateral subdural effusions related to disease activity in familial hemophagocytic lymphohistiocytosis in an 8-month-old infant.An 8-month-old girl had classic features of hemophagocytic lymphohistiocytosis (HLH). A presumptive diagnosis of familial hemophagocytic lymphohistiocytosis was made on the basis of her age and the presence of parental consanguinity. In view of abnormal neurologic findings at presentation, a magnetic resonance imaging scan was performed and showed bilateral proteinaceous subdural effusions. These resolved within 1 week of commencement of chemotherapy for the primary condition. These subdural effusions were the only objective documentations of central nervous system involvement, along with an increased cerebrospinal fluid protein level. We also report other radiologic findings of HLH, which are of use in strengthening this diagnosis in individuals in whom the diagnosis is strongly suspected.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
9/55. Discrepant time course of cranial and spinal subdural collections in a case of SIH treated by EBP.The MR monitoring of a patient with acute spontaneous intracranial hypotension successfully treated by epidural blood patch revealed strikingly different time course of the initially concomitant cranial and spinal subdural fluid collections. This undescribed feature suggested different pathophysiological mechanisms for the disorder in the two locations and should be kept in mind when imaging patients with the condition.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
10/55. posture-related headaches and pachymeningeal enhancement in CSF leaks from craniotomy site.cerebrospinal fluid (CSF) leak is recognized to cause headaches that typically but not invariably have orthostatic features (present in upright posture, relieved by recumbency). Head magnetic resonance imaging (MRI) typically shows diffuse pachymeningeal enhancement. A 24-year-old woman, after resection of a right temporoparietal glioma, developed CSF leak from the craniotomy site, resulting in subgaleal fluid collection and associated with diffuse pachymeningeal gadolinium enhancement as well as posture-related headaches. The headaches, however, were present in a recumbent position and relieved after several minutes of being in an upright position. It is postulated that CSF leak took place when the patient was recumbent and ceased when she was upright, a position in which there is decrease in intracranial pressure. After cessation of the leak, along with disappearance of subgaleal collection of CSF, both the headaches and the pachymeningeal enhancement resolved.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
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