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Headache Jun 2024A cerebrospinal fluid (CSF) leak developed in a 14-year-old girl and a 12-year-old boy following a diagnostic lumbar puncture. Two days and sixteen years later,...
A cerebrospinal fluid (CSF) leak developed in a 14-year-old girl and a 12-year-old boy following a diagnostic lumbar puncture. Two days and sixteen years later, respectively, paraplegia developed due to a functional disorder. Imaging revealed an extensive extradural CSF collection in both patients and digital subtraction myelography was required to pinpoint the exact site of a ventral dural puncture hole where the lumbar spinal needle had gone "through and through" the dural sac. The CSF leak was complicated by cortical vein thrombosis in one patient. Both patients underwent uneventful surgical repair of the ventral dural puncture hole with prompt resolution of the paraplegia. Iatrogenic ventral CSF leaks may become exceptionally long standing and may be complicated by paraplegia on a functional basis both in the acute and chronic phases.
PubMed: 38860510
DOI: 10.1111/head.14749 -
Journal of Clinical Neuroscience :... May 2023Spontaneous intracranial hypotension from spinal cerebrospinal fluid leak is a condition that often presents as orthostatic headaches. Diagnosis and localisation of... (Review)
Review
Spontaneous intracranial hypotension from spinal cerebrospinal fluid leak is a condition that often presents as orthostatic headaches. Diagnosis and localisation of spinal CSF leaks remain difficult despite multiple imaging modalities that can be used to aid identification. These include traditional CT myelography and MRI as well as newer techniques such as dynamic and digital subtraction myelography. Leaks can be classified into types and optimal localisation and management techniques vary by type of leak. Localisation of a leak can aid in targeting treatment such as an epidural blood patch if conservative measures fail. Where unsuccessful, repeated blood patches and novel techniques can be used to improve patient symptoms. Much of this condition is not well understood and evidence is lacking, with many avenues for potential research.
Topics: Humans; Intracranial Hypotension; Cerebrospinal Fluid Leak; Myelography; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Blood Patch, Epidural
PubMed: 36948109
DOI: 10.1016/j.jocn.2023.03.005 -
Neurologic Clinics May 2024Spontaneous intracranial hypotension (SIH) typically presents as an acute orthostatic headache during an upright position, secondary to spinal cerebrospinal fluid leaks.... (Review)
Review
Spontaneous intracranial hypotension (SIH) typically presents as an acute orthostatic headache during an upright position, secondary to spinal cerebrospinal fluid leaks. New evidence indicates that a lumbar puncture may not be essential for diagnosing every patient with SIH. Spinal neuroimaging protocols used for diagnosing and localizing spinal cerebrospinal fluid leaks include brain/spinal MRI, computed tomography myelography, digital subtraction myelography, and radionuclide cisternography. Complications of SIH include subdural hematoma, cerebral venous thrombosis, and superficial siderosis. Treatment options encompass conservative management, epidural blood patches, and surgical interventions. The early application of epidural blood patches in all patients with SIH is suggested.
Topics: Humans; Intracranial Hypotension; Cerebrospinal Fluid Leak; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Neuroimaging; Headache
PubMed: 38575260
DOI: 10.1016/j.ncl.2024.02.002 -
Neuroradiology Feb 2023Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating... (Review)
Review
Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
Topics: Humans; Intracranial Hypotension; Cerebrospinal Fluid Leak; Myelography; Magnetic Resonance Imaging; Endovascular Procedures
PubMed: 36336758
DOI: 10.1007/s00234-022-03079-5 -
European Neurology 2020In this article, we commemorate the centenary of myelography, a neuroradiological procedure that, despite certain disadvantages, significantly contributed to the... (Review)
Review
In this article, we commemorate the centenary of myelography, a neuroradiological procedure that, despite certain disadvantages, significantly contributed to the diagnosis and localization of spinal cord lesions during the 20th century. From the start, the use of myelography was characterized by different views regarding the potential dangers associated with the prolonged exposure of a "foreign body" to the central nervous system. Such differences in attitude resulted in divergent myelography practices; its precise indications, technical performance, and adopted contrast material remaining subject to variability until the procedure were eventually replaced by MRI at the close of the 20th century.
Topics: Female; History, 20th Century; History, 21st Century; Humans; Male; Myelography; Spinal Cord Diseases
PubMed: 32871581
DOI: 10.1159/000509863 -
Neuroimaging Clinics of North America Nov 2022The spinal cord is an elegant structure that serves as a conduit for the transfer of information between the brain and the peripheral nervous system. To enable the... (Review)
Review
The spinal cord is an elegant structure that serves as a conduit for the transfer of information between the brain and the peripheral nervous system. To enable the reader to understand its complex microstructural anatomy, we have created a detailed yet approachable anatomic reference for clinicians. We review gross and structural features of the spinal cord, its coverings, and nerves while also discussing spinal cord development, microscopic organization, and common anatomic variants. We detail how this anatomy appears on current neuroimaging techniques, with special attention to MR imaging.
Topics: Humans; Magnetic Resonance Imaging; Spinal Cord
PubMed: 36244730
DOI: 10.1016/j.nic.2022.07.025 -
Radiologie (Heidelberg, Germany) Oct 2022Imaging of the postoperative spine intends to answer two main questions: It is used to assess the surgical success and to identify complications. To this end,... (Review)
Review
Imaging of the postoperative spine intends to answer two main questions: It is used to assess the surgical success and to identify complications. To this end, conventional X‑ray, computer tomography (CT), myelography, and magnetic resonance imaging (MRI) are available. The radiologist has to select the appropriate modality for sufficient diagnosis considering the preoperative situation, the performed operation, and existing postoperative symptoms. Particularly, the implantation of foreign material represents a technical challenge in the context of image acquisition. In the radiologist's report, one must differentiate between expected postoperative changes and relevant complications. Close communication with the patients and the referring clinicians is essential. Especially clinical signs of infection, new or progressive neurological deficits and cauda equina and conus medullaris syndromes require an immediate diagnosis to facilitate prompt therapy.
Topics: Cauda Equina; Humans; Musculoskeletal System; Myelography; Spinal Cord Compression; Spine; Tomography, X-Ray Computed
PubMed: 35789426
DOI: 10.1007/s00117-022-01034-2 -
World Neurosurgery: X Apr 2024To formulate the most current, evidence-based recommendations regarding the epidemiology, clinical diagnosis, and radiographic diagnosis of lumbar herniated disk (LDH). (Review)
Review
OBJECTIVE
To formulate the most current, evidence-based recommendations regarding the epidemiology, clinical diagnosis, and radiographic diagnosis of lumbar herniated disk (LDH).
METHODS
A systematic literature search in PubMed, MEDLINE, and CENTRAL was performed from 2012 to 2022 using the search terms "herniated lumbar disc", "epidemiology", "prevention" "clinical diagnosis", and "radiological diagnosis". Screening criteria resulted in 17, 16, and 90 studies respectively that were analyzed regarding epidemiology, clinical diagnosis, and radiographic diagnosis of LDH. Using the Delphi method and two rounds of voting at two separate international meetings, ten members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated eleven final consensus statements.
RESULTS
The lifetime risk for symptomatic LDH is 1-3%; of these, 60-90% resolve spontaneously. Risk factors for LDH include genetic and environmental factors, strenuous activity, and smoking. LDH is more common in males and in 30-50 year olds. A set of clinical tests, including manual muscle testing, sensory testing, Lasegue sign, and crossed Lasegue sign are recommended to diagnose LDH. Magnetic resonance imaging (MRI) is the gold standard for confirming suspected LDH.
CONCLUSIONS
These eleven final consensus statements provide current, evidence-based guidelines on the epidemiology, clinical diagnosis, and radiographic diagnosis of LDH for practicing spine surgeons worldwide.
PubMed: 38440379
DOI: 10.1016/j.wnsx.2024.100279 -
Child's Nervous System : ChNS :... Jul 2022Perinatal brachial plexus palsy (PBPP) has a wide spectrum of clinical symptoms that can range from incomplete paresis of the affected extremity to flaccid arm... (Review)
Review
PURPOSE
Perinatal brachial plexus palsy (PBPP) has a wide spectrum of clinical symptoms that can range from incomplete paresis of the affected extremity to flaccid arm paralysis. Although there is a high rate of spontaneous recovery within the first two years of life, it remains challenging to determine which patients will benefit most from surgical intervention. The diagnostic and predictive use of various imaging modalities has been described in the literature, but there is little consensus on approach or algorithm. The anatomic, pathophysiological, and neurodevelopmental characteristics of the neonatal and infant patient population affected by PBPP necessitate thoughtful consideration prior to selecting an imaging modality.
METHODS
A systematic review was conducted using six databases. Two reviewers independently screened articles published through October 2021.
RESULTS
Literature search produced 10,329 publications, and 22 articles were included in the final analysis. These studies included 479 patients. Mean age at time of imaging ranged from 2.1 to 12.8 months and investigated imaging modalities included MRI (18 studies), ultrasound (4 studies), CT myelography (4 studies), and X-ray myelography (1 study). Imaging outcomes were compared against surgical findings (16 studies) or clinical examination (6 studies), and 87.5% of patients underwent surgery.
CONCLUSION
This systematic review addresses the relative strengths and challenges of common radiologic imaging options. MRI is the most sensitive and specific for identifying preganglionic nerve injuries such as pseudomeningoceles and rootlet avulsion, the latter of which has the poorest prognosis in this patient population and often dictates the need for surgical intervention.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Infant; Infant, Newborn; Myelography; Paralysis; Sensitivity and Specificity
PubMed: 35536348
DOI: 10.1007/s00381-022-05538-z -
Acta Radiologica (Stockholm, Sweden :... Nov 2021This review focuses on the trends in contrast media (CM) research published in during the last 100 years, since the first edition in 1921. The main topics covered are... (Review)
Review
This review focuses on the trends in contrast media (CM) research published in during the last 100 years, since the first edition in 1921. The main topics covered are the developments of iodine- and gadolinium-based CM. Other topics include manganese-based CM for magnetic resonance imaging (MRI) and barium for the investigation of the alimentary tract. From a historic point of view, special CM for use in cholegraphy and myelography are addressed in the review. Today, these imaging procedures are obsolete due to the development of computed tomography, MRI, and ultrasound. The historical use of radioactive thorium-based CM for angiography is also addressed. Furthermore, publications on adverse reactions to CM are reviewed.
Topics: Barium; Bibliometrics; Bile Ducts; Contrast Media; Gadolinium; History, 20th Century; History, 21st Century; Humans; Iodine; Magnetic Resonance Imaging; Manganese; Myelography; Periodicals as Topic; Research
PubMed: 34636678
DOI: 10.1177/02841851211051014