False localization of CSF leak on nuclear medicine myelogram

Case contributed by Frank Gaillard
Diagnosis almost certain

Presentation

Low pressure headache suggestive of CSF leak.

Patient Data

Age: 40 years
Gender: Female

Myelogram

Nuclear medicine

Increased activity is noted on the left at C1/2 level. This should not be interpreted as being the site of leakage, as CSF in the epidural space can ascend and exit the canal at this level. It is known as a false localizing sign, also encountered on CT myelography. 

Case Discussion

This patient had a thoracic calcified disc eventually identified as the cause and was treated successfully with a blood patch. 

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