CSF–venous fistula in spontaneous intracranial hypotension
Abstract
Spontaneous intracranial hypotension (SIH) is an important cause of new daily persistent headaches.1 In most patients, the underlying cause is a CSF leak, always at the level of the spine.2 Once escaped into the epidural space, CSF is rapidly absorbed by the spinal epidural venous plexus, which is often maximally dilated in the setting of SIH. With conventional imaging, the presence of contrast in epidural veins has not been demonstrated in SIH, but indirect evidence for rapid venous absorption such as contrast in the renal collection system on CT myelography or early activity of tracer in the bladder on nuclear cisternography is common.1 We report the radiographic demonstration of direct CSF–venous fistulae in patients with SIH using digital subtraction myelography (DSM). DSM allows real-time high-resolution imaging of contrast injected through a lumbar puncture.3–5
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References
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© 2014 American Academy of Neurology.
Publication History
Received: October 4, 2013
Accepted: March 13, 2014
Published online: June 20, 2014
Published in issue: July 29, 2014
Funding Information
Study funding: No targeted funding reported.Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
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Cited By
- Intracranial pressure monitoring in patients with spontaneous onset of orthostatic headache, The Journal of Headache and Pain, 26, 1, (2025).https://doi.org/10.1186/s10194-024-01928-7
- Role of CT myelography in the diagnosis and management of spontaneous intracranial hypotension, Clinical Neurology and Neurosurgery, 249, (108707), (2025).https://doi.org/10.1016/j.clineuro.2024.108707
- CSF-Venous Fistulas Arising Intraosseously within Bone Remodeled by Meningeal Diverticula, American Journal of Neuroradiology, 46, 2, (421-425), (2025).https://doi.org/10.3174/ajnr.A8507
- Azygos Vein Stenosis in Frontotemporal Dementia Sagging Brain Syndrome, American Journal of Neuroradiology, 46, 2, (408-415), (2025).https://doi.org/10.3174/ajnr.A8532
- Introduction to Digital Subtraction Myelography for CSF-Venous Fistula Detection, American Journal of Neuroradiology, 46, 1, (219-219), (2025).https://doi.org/10.3174/ajnr.A8587
- Apport de la cisternographie isotopique dans la recherche de fuite du liquide céphalorachidien, Médecine Nucléaire, (2025).https://doi.org/10.1016/j.mednuc.2024.10.010
- Reply: Dementia in spontaneous intracranial hypotension: look at the spine, Neuroradiology, 67, 1, (3-5), (2024).https://doi.org/10.1007/s00234-024-03529-2
- Dementia in spontaneous intracranial hypotension: a call for accurate terminology, Neuroradiology, 67, 1, (1-2), (2024).https://doi.org/10.1007/s00234-024-03530-9
- Surgical treatment of spontaneous intracranial hypotension, Neurologie pro praxi, 25, 5, (373-378), (2024).https://doi.org/10.36290/neu.2024.004
- Assessing the Diagnostic Value of Brain White Matter Hyperintensities and Clinical Symptoms in Predicting the Detection of CSF-Venous Fistula in Patients with Suspected Spontaneous Intracranial Hypotension, American Journal of Neuroradiology, (2024).https://doi.org/10.3174/ajnr.A8548
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