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Case Reports
. 2016 Jul;37(7):1379-81.
doi: 10.3174/ajnr.A4682. Epub 2016 Feb 11.

The "Hyperdense Paraspinal Vein" Sign: A Marker of CSF-Venous Fistula

P G Kranz  1 , T J Amrhein  2 , W I Schievink  3 , I O Karikari  4 , L Gray  2
Affiliations
Case Reports

The "Hyperdense Paraspinal Vein" Sign: A Marker of CSF-Venous Fistula

P G Kranz et al. AJNR Am J Neuroradiol. 2016 Jul.

Abstract

CSF-venous fistula is a recently reported cause of spontaneous intracranial hypotension that may occur in the absence of myelographic evidence of CSF leak. Information about this entity is currently very limited, but it is of potential importance given the large percentage of cases of spontaneous intracranial hypotension associated with negative myelography findings. We report 3 additional cases of CSF-venous fistula and describe the "hyperdense paraspinal vein" sign, which may aid in its detection.

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Figures

Fig 1.
Fig 1.
A 34-year-old woman with SIH. A, Coronal image from a CT myelogram shows a low-flow CSF leak inferior to the left T8 nerve root (arrow). B, A subsequent dynamic myelogram obtained with the patient in the left lateral decubitus position shows the area of the leak (arrow) with a fistula to an adjacent paraspinal vein (arrowhead). C, Axial image from her original CT myelogram reveals a hyperattenuated paraspinal vein (arrow). D, Postprocessed image with thresholded color overlay depicting attenuation values from 60 to 140 HU helps improve the conspicuity of this hyperattenuated vein.
Fig 2.
Fig 2.
A 56-year-old man with SIH. A, Axial image from a CT myelogram shows a low-flow CSF leak in the right neural foramen at T10–11 (arrowhead). An adjacent hyperattenuated paraspinal vein (arrow) is seen. B, Postprocessed image with thresholded color overlay depicting attenuation values from 60 to 140 HU improves the conspicuity of this hyperattenuated vein (arrow). C, Coronal image with thresholded color overlay demonstrates that only the vein at the level and side of the fistula (arrow) shows increased attenuation.
Fig 3.
Fig 3.
A 59-year-old woman with SIH. A, Axial image from a CT myelogram shows a hyperattenuated paraspinal vein (arrow) at T6–7 on the right. B, A subsequent digital subtraction myelogram shows a CSF-venous fistula at this location (arrow). C, Postprocessed image with thresholded color overlay depicting attenuation values from 60 to 140 HU again helps with the identification of this finding (arrow). D, Axial image from an adjacent level (T8–9) where there was no fistula is provided for comparison. Note that the paraspinal vein is not hyperattenuated (arrowhead) and is not identified on the thresholded color overlay.
See this image and copyright information in PMC

References

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