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AJNR - American Journal of Neuroradiology

Published ahead of print on June 26, 2008
doi: 10.3174/ajnr.A1157

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American Journal of Neuroradiology 29:1627-1629, October 2008
© 2008 American Society of Neuroradiology

Case Report
SPINE

Emergent Image-Guided Treatment of a Large CSF Leak to Reverse "In-Extremis" Signs of Intracranial Hypotension

A.A. Lasboo^a, M.C. Hurley^a,b, M.T. Walker^a, D. Surdell^a,b, J.K. Song^b, J.M. Rosenow^b and A. Shaibani^a,b

^a Departments of Radiology, The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Ill
^b Neurological Surgery, The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Ill

Please address correspondence to Ali Shaibani, MD, Department of Radiology, 676 North St. Clair, Suite 800, Chicago, IL 60611; e-mail: AShaibani{at}nmff.org

SUMMARY: We report the use of an emergent, targeted fibrin spinal epidural blood patch with subarachnoid saline infusion to rapidly reverse "in-extremis" clinical and imaging signs of posterior-fossa coning brought about by acute-on-chronic intracranial hypotension, itself consequent to a cervicothoracic CSF leak. Treatment resulted in a dramatic recovery and eventual discharge with return to normal lifestyle and occupation. The clinical and imaging danger signs are reviewed; fibrin patch technique and potential pitfalls in postprocedure management are analyzed.