Advanced

AJNR - American Journal of Neuroradiology

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

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 Lasboo, A.A. Articles by Shaibani, A. Search for Related Content PubMed PubMed Citation Articles by Lasboo, A.A. Articles by Shaibani, A.

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

View larger version (80K): [in this window] [in a new window]   Fig 1. A, T2 sagittal MR imaging of the thoracolumbar spine with fat saturation shows a longitudinal posterior epidural fluid collection (arrows). B, T2 axial MR imaging through the T8 vertebra shows the posterior epidural fluid collection (arrow) extending around the sides of the thecal sac.

View larger version (78K): [in this window] [in a new window]   Fig 2. A, Spot anteroposterior (AP) radiograph of the lower cervical spine shows placement of the first C5-C6 sublaminar posterior epidural needle. B, Spot AP radiograph of the cervicodorsal spine shows placement of the second and third posterior epidural needles at the T1–T2 and T4–T5 levels.

View larger version (88K): [in this window] [in a new window]   Fig 3. A, Midline noncontrast T1 sagittal brain MR imaging before emergent fibrin epidural patch demonstrates severe crowding of the posterior fossa with effacement of the basal cisterns and tonsillar descent through the foramen magnum (broken line). Note acute angulation of the distal basilar artery (arrow) and compression of the vein of Galen by the splenium of the corpus callosum (arrowhead). B, Repeat MR imaging with the same parameters performed 2 weeks after treatment and recovery. There is a normal appearance of the posterior fossa cisterns and gentle curvature of the basilar artery with resolution of distal kinking (arrow). Encephalomalacia in the splenium (arrowhead) from ischemia, which likely occurred because of compression of the splenial artery or draining veins.