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. 2008 May;29(5):853-6.
doi: 10.3174/ajnr.A0956. Epub 2008 Feb 7.

Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension

W I Schievink  1 , M M Maya, C Louy, F G Moser, J Tourje
Affiliations

Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension

W I Schievink et al. AJNR Am J Neuroradiol. 2008 May.

Abstract

Background and purpose: Comprehensive diagnostic criteria encompassing the varied clinical and radiographic manifestations of spontaneous intracranial hypotension are not available. Therefore, we propose a new set of diagnostic criteria.

Materials and methods: The diagnostic criteria are based on results of brain and spine imaging, clinical manifestations, results of lumbar puncture, and response to epidural blood patching. The diagnostic criteria include criterion A, the demonstration of extrathecal CSF on spinal imaging. If criterion A is not met, criterion B, which is cranial MR imaging findings of spontaneous intracranial hypotension, follows, with at least one of the following: 1) low opening pressure, 2) spinal meningeal diverticulum, or 3) improvement of symptoms after epidural blood patch. If criteria A and B are not met, there is criterion C, the presence of all of the following or at least 2 of the following if typical orthostatic headaches are present: 1) low opening pressure, 2) spinal meningeal diverticulum, and 3) improvement of symptoms after epidural blood patch. These criteria were applied to a group of 107 consecutive patients evaluated for spontaneous spinal CSF leaks and intracranial hypotension.

Results: The diagnosis was confirmed in 94 patients, with use of criterion A in 78 patients, criterion B in 11 patients, and criterion C in 5 patients.

Conclusions: A new diagnostic scheme is presented reflecting the wide spectrum of clinical and radiographic manifestations of spontaneous spinal CSF leaks and intracranial hypotension.

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Figures

Fig 1.
Fig 1.
Postmyelography CTs showing (A) bilateral cervicothoracic CSF leaks without an associated meningeal diverticulum; B, Left thoracic meningeal diverticulum with an associated CSF leak; and C, right thoracic meningeal diverticulum without an associated CSF leak.
Fig 2.
Fig 2.
A, Brain MR images showing typical findings in spontaneous intracranial hypotension with a coronal T2-weighted image showing subdural fluid collections; B, a coronal gadolinium-enhanced T1-weighted image showing enhancement of the pachymeninges; and C, a T1-weighted sagittal image showing sagging of the brain.
See this image and copyright information in PMC

Comment in

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