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Clinical/Scientific Notes
June 20, 2014

CSF–venous fistula in spontaneous intracranial hypotension

July 29, 2014 issue
83 (5) 472-473

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

1.
Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006;295:2286–2296.
2.
Schievink WI, Schwartz MS, Maya MM, Moser FG, Rozen TD. Lack of causal association between spontaneous intracranial hypotension and cranial cerebrospinal fluid leaks. J Neurosurg 2012;116:749–754.
3.
Phillips CD, Kaptain GJ, Razack N. Depiction of a postoperative pseudomeningocele with digital subtraction myelography. AJNR Am J Neuroradiol 2002;23:337–338.
4.
Hoxworth JM, Trentman TL, Kotsenas AL, Thielen KR, Nelson KD, Dodick DW. The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol 2012;199:649–653.
5.
Carstensen M, Chaudhary N, Leung A, Ng W. Supine digital subtraction myelography for the demonstration of a dorsal cerebrospinal fluid leak in a patient with spontaneous intracranial hypotension: a technical note. J Radiol Case Rep 2012;6:1–9.
6.
Maillot CI. The space surrounding the spinal cord: constitution, organization and relationship with the cerebrospinal fluid. J Radiol 1990;71:539–547.
7.
Lin PM, Clarke J. Spinal fluid-venous fistula: a mechanism for intravascular pantopaque infusion during myelography: report of two cases. J Neurosurg 1974;41:773–776.

Information & Authors

Information

Published In

Neurology®
Volume 83Number 5July 29, 2014
Pages: 472-473
PubMed: 24951475

Publication History

Received: October 4, 2013
Accepted: March 13, 2014
Published online: June 20, 2014
Published in print: July 29, 2014

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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.

Authors

Affiliations & Disclosures

Wouter I. Schievink, MD
From Cedars-Sinai Medical Center, Los Angeles, CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
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NONE
Franklin G. Moser, MD, MMM
From Cedars-Sinai Medical Center, Los Angeles, CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
M. Marcel Maya, MD
From Cedars-Sinai Medical Center, Los Angeles, CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Schievink: [email protected]

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Cited By
  1. Spontaneous Intracranial Hypotension: Case Report and Update on Diagnosis and Treatment, Diagnostics, 14, 9, (881), (2024).https://doi.org/10.3390/diagnostics14090881
    Crossref
  2. Spinal CSF Leaks: The Neuroradiologist Transforming Care, American Journal of Neuroradiology, 45, 11, (1613-1620), (2024).https://doi.org/10.3174/ajnr.A8484
    Crossref
  3. Spontaneous Intracranial Hypotension in Children: A Multi-Institutional Review of Spinal CSF Leaks Localized on Advanced Myelography, American Journal of Neuroradiology, (2024).https://doi.org/10.3174/ajnr.A8430
    Crossref
  4. Diagnostic Yield of Decubitus CT Myelography for Detection of CSF-Venous Fistulas, American Journal of Neuroradiology, (2024).https://doi.org/10.3174/ajnr.A8330
    Crossref
  5. Myelographic Techniques for the Localization of CSF-Venous Fistulas: Updates in 2024, American Journal of Neuroradiology, (2024).https://doi.org/10.3174/ajnr.A8299
    Crossref
  6. Lateral Spinal CSF Leaks in Patients with Spontaneous Intracranial Hypotension: Radiologic-Anatomic Study of Different Variants, American Journal of Neuroradiology, 45, 7, (951-956), (2024).https://doi.org/10.3174/ajnr.A8261
    Crossref
  7. Perspectives from the Inaugural “Spinal CSF Leak: Bridging the Gap” Conference: A Convergence of Clinical and Patient Expertise, American Journal of Neuroradiology, 45, 7, (841-849), (2024).https://doi.org/10.3174/ajnr.A8181
    Crossref
  8. Optic Nerve Sheath MR Imaging Measurements in Patients with Orthostatic Headaches and Normal Findings on Conventional Imaging Predict the Presence of an Underlying CSF-Venous Fistula, American Journal of Neuroradiology, 45, 5, (655-661), (2024).https://doi.org/10.3174/ajnr.A8165
    Crossref
  9. Cerebrospinal fluid-venous fistula visualisation by intrathecal pressurization: A technical note and illustrative case, The Neuroradiology Journal, (2024).https://doi.org/10.1177/19714009241269487
    Crossref
  10. CSF-venous fistulas associated with traumatic spinal pseudomeningoceles, Interventional Neuroradiology, (2024).https://doi.org/10.1177/15910199241276575
    Crossref
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