[Radionuclide cisternography in spontaneous intracranial hypotension syndrome]

Abstract

Spontaneous intracranial hypotension (SHI) due to cerebrospinal fluid (CSF) leaks is a clinical entity that is being increasingly recognized. Orthostatic headache is the cardinal clinical manifestation of this disorder.

Patients and method: Seven patients were studied retrospectively because of postural headache associated with low CSF pressure. In all patients, radionuclide cisternography as well as CT and/or MRI were performed. Radionuclide cisternography was obtained after intrathecal injection of radioisotope into the lumbar subarachnoide space. Images were obtained at 30 minutes, 2 and 4 hours after the injection. Pledgets were inserted into the nose and were considered positive for the presence of CSF when the count index of the pledgets regarding a blood sample was > or = 2:1. Criteria of spontaneous SHI was the early appearance of bladder activity with decrease in the distribution in the cerebral convexity and/or visualization of activity in the paraspinal areas.

Results: In 5 of the 7 patients scintigraphic abnormalities were found.

Conclusion: Radionuclide cisternography is a reliable diagnostic method to diagnose SHI.