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Case Reports
. 2020 Apr 29;20(1):162.
doi: 10.1186/s12883-020-01740-1.

Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture

Tommy Lik Hang Chan  1 , Robert Cowan  2 , Nada Hindiyeh  2 , Syed Hashmi  3 , Bryan Lanzman  3 , Ian Carroll  4
Affiliations
Case Reports

Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture

Tommy Lik Hang Chan et al. BMC Neurol. .

Abstract

Background: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak.

Methods: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. Targeted epidural patches with fibrin sealant were performed. Treatment response at return visit (3 months post-patch) was documented.

Results: Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity.

Conclusion: Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site.

Keywords: Intracranial hypotension; Pars interarticularis fracture; Spinal CSF leak; Spinal cerebrospinal fluid leak.

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Conflict of interest statement

The authors have no conflicts of interest (financial or non-financial) to disclose relevant to this study.

Figures

Fig. 1
Fig. 1
a Patient 1 b Patient 2: Magnetic Resonance Imaging with gadolinium (Coronal T1 Spoiled Recalled Gradient-Echo) demonstrated diffuse pachymeningeal enhancement (arrows), a feature of intracranial hypotension. c: Patient 2: Magnetic Resonance Imaging (Coronal T1) demonstrated subdural collections (arrow), a feature of intracranial hypotension
Fig. 2
Fig. 2
Computed Tomography Myelogram (axial view) demonstrated a ventral cervicothoracic epidural CSF collection (arrow) extending from the mid cervical spine to mid thoracic level (Patient 1)
Fig. 3
Fig. 3
Computed Tomography Myelogram (axial view) demonstrated bilateral L5 pars interarticularis fractures (arrows) (Patient 1)
See this image and copyright information in PMC

References

    1. Mea E, Chiapparini L, Savoiardo M, Franzini A, Bussone G, Leone M. Clinical features and outcomes in spontaneous intracranial hypotension: a survey of 90 consecutive patients. Neurol Sci. 2009;30(Suppl 1):S11–S13. - PubMed
    1. Ferrante E, Savino A. Nonpostural headache by spontaneous intracranial hypotension. Headache. 2003;43(2):127–129. - PubMed
    1. Wang S-J, Fuh J-L. Exertional but not postural headache resulting from spontaneous intracranial hypotension. Acta Neurol Taiwanica. 2005;14(1):36–37. - PubMed
    1. Schievink WI, Smith KA. Nonpositional headache caused by spontaneous intracranial hypotension. Neurology. 1998;51(6):1768–1769. - PubMed
    1. Leep Hunderfund AN, Mokri B. Second-half-of-the-day headache as a manifestation of spontaneous CSF leak. J Neurol. 2012;259(2):306–310. - PubMed

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