This case illustrates a high-volume leak, making localization of the actual leak difficult. One should refrain from interpreting areas of contrast extending beyond the epidural space as being localizing in the setting of abundant epidural contrast. This is especially true posteriorly at C1/C2 where it is a recognized false localizing sign.

Rather, a scan with temporal high resolution should be performed, or treatment with a lumbar epidural can be performed speculatively. The latter was performed in this case, and the patient became, and has remained symptom free.