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| NEUROIMAGES |
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| Year : 2016 | Volume
: 64
| Issue : 6 | Page : 1378-1379 |
An unusual cause of severe headache: Spontaneous dorsal cerebrospinal fluid leakage
Serkan Aribal1, Onur L Ulusoy2, Ersin Ozturk3, Ayhan Mutlu2, Sadık Server2
1 Department of Radiology, Aksaz Military Hospital, Marmaris, Muğla, Turkey
2 Department of Radiology, İstanbul Florence Nightingale Hospital, Şişli, İstanbul, Turkey
3 Department of Radiology, GATA Haydarpaşa Teaching Hospital, Üsküdar, İstanbul, Turkey
| Date of Web Publication | 11-Nov-2016 |
Correspondence Address:
Dr. Serkan Aribal
Department of Radiology, Aksaz Military Hospital, Radiology Service Marmaris - 48750, Muğla
Turkey
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.193813
How to cite this article:
Aribal S, Ulusoy OL, Ozturk E, Mutlu A, Server S. An unusual cause of severe headache: Spontaneous dorsal cerebrospinal fluid leakage. Neurol India 2016;64:1378-9 |
A 38-year-old female patient presented with new onset of severe orthostatic headache. Diffuse and prominent contrast enhancement in the dural structures, and caudal displacement of the brain stem into the craniocervical region suggestive of intracranial hypotension, were observed on her cranial and cervical magnetic resonance images (MRI) [Figure 1]. Therefore, the next step was the dorsal spinal MRI to demonstrate a possible pathology. In her dorsal MRI, an abnormal fluid signal was seen, instead of the normal fat signal, throughout the posterior epidural tissue [Figure 2]. Therefore, computed tomographic myelography was performed, and a distinct contrast material leakage into the posterior epidural space was observed [Figure 3]. As the patient had no history of trauma, surgery, or any kind of intervention, the case was diagnosed as spontaneous dorsal cerebrospinal fluid leakage.[1] The patient underwent a thoracic epidural blood patch procedure for treatment.[2] After 2 weeks, with two interventions, all the symptoms progressively resolved. | Figure 1: Axial (a) and (b) coronal contrast-enhanced T1-weighted magnetic resonance images showing diffuse and prominent contrast enhancement in the dural structures. (c) Caudal displacement of the brain stem into the craniocervical region was seen on sagittal T2-weighted cervical magnetic resonance image
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 | Figure 2: Sagittal T2-weighted (a), T1-weighted (b), short tau inversion recovery (c), and axial T2-weighted magnetic resonance images (d). Fluid signal was seen in place of normal fat signal throughout the posterior epidural tissue (between two opposing white arrows in a–c and white arrows in d)
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 | Figure 3: Axial computed tomography myelographic image. Contrast agent leakage is seen posterior to the posterior epidural space (black arrows)
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006;295:2286-96.  |
| 2. | Su CS, Lan MY, Chang YY, Lin WC, Liu KT. Clinical features, neuroimaging and treatment of spontaneous intracranial hypotension and magnetic resonance imaging evidence of blind epidural blood patch. Eur Neurol 2009;61:301-7. |
[Figure 1], [Figure 2], [Figure 3]
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