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Extradural spinal CSF leak

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Headache and backache beginning 3 days after spontaneous delivery with epidural anesthesia.

Patient Data

Age: 25 years
Gender: Female
mri

Extradural CSF collections in the spinal canal - anterior along the C-spine, posterior along the T-spine, and anterior along the L-spine. The dura mater is thickened and enhances, in keeping with CSF leak.
The spinal cord is of normal thickness and signal intensity.
No clinically relevant disc bulge or herniation.


Cavitary cystic lesions and nodules in the right lung apex.

 

 

mri

Narrow ventricles, cisterns and sulci.
The dura mater is thickened and enhances, including the falx cerebri and tentorium cerebelli - an expression of decreased intracranial pressure.
Small thrombus in a right parietal dural vein posterior to the vein of Trolard, adjacent to the superior sagittal sinus (SSS). Several additional thrombi on both sides of the SSS at the vertex.

Case Discussion

The patient received a blood patch for the CSF leak, with partial symptomatic relief.

She was started on clopidogrel for the cortical vein thrombosis . A follow-up MRI head done 4 days later showed that the thrombi had dissolved.

As for the RUL lesions, bronchoscopy was performed and the bronchial washings were stained for mycobacteria - acid-fast bacilli were detected. She was promptly started on combined antibiotic therapy for tuberculosis.

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