Presentation
Spontaneous intracranial hypotension, failed blood patch x4, negative CT myelography.
Patient Data
Age: 45 years
Gender: Female
From the case:
MRI myelogram with gadolinium
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/46709/annotated_viewer_json?lang=us"}
No evidence of contrast leak/extravasation, particularly at the T8 level. Several scattered tiny nerve root sheath cysts/diverticula noted.
From the case:
MRI myelogram with gadolinium
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/46711/annotated_viewer_json?lang=us"}
MR thoracic myelogram (with intrathecal gadolinium) has been performed with T1 fat suppressed sequences through the thoracic spine at 1 hours and again at 4.5 hours post injection. There is still no evidence of contrast leak/extravasation.
Case Discussion
Identifying slow CSF leaks can be challenging at it is not uncommon for this to require multiple examinations. Blood patch performed speculatively is a very reasonable approach and often results in successful treatment.
Unable to process the form. Check for errors and try again.