Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Rai, A. Articles by Miele, V. Search for Related Content PubMed PubMed Citation Articles by Rai, A. Articles by Miele, V.

Epidural Blood Patch at C2: Diagnosis and Treatment of Spontaneous Intracranial Hypotension

Ansaar Rai^a,b, Charles Rosen^b, Jeffrey Carpenter^a and Vincent Miele^b

^a Department of Radiology, West Virginia University, Morgantown, WV
^b Department of Neurosurgery, West Virginia University, Morgantown, WV

View larger version (133K): [in a new window]   FIG 1. Midsection sagittal T1-weighted image obtained without contrast material shows tonsillar descent almost to the arch of C1.

View larger version (83K): [in a new window]   FIG 2. Axial postcontrast T1-weighted (A) and coronal postcontrast fast spoiled gradient-recalled echo (B) sequences show diffuse meningeal enhancement.

View larger version (53K): [in a new window]   FIG 3. Axial thin-section CT images obtained through the C1-C2 (A) and the C2 (B) levels show epidural contrast material accumulation on the left side, with the possible site of leakage at the C1-C2 level.

View larger version (62K): [in a new window]   FIG 4. Two axial CT images obtained with the patient in the prone position show needle placement in the left lateral epidural compartment at the upper C2 level (A) followed by administration of the blood patch; contrast material injected to confirm the epidural location is identified with mild flattening of the lateral thecal sac margin (B).

View larger version (151K): [in a new window]   FIG 5. Midsection sagittal T1-weighted image obtained without contrast material shows resolution of the tonsillar descent. This measured less than 3 mm compared with the initial measurement of 8 mm. Compare with Fig 1.

View larger version (82K): [in a new window]   FIG 6. Axial postcontrast T1-weighted (A) and coronal postcontrast fast spoiled gradient-recalled echo (B) sequences show resolution of the diffuse dural enhancement. Compare with Fig 2.