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Abstract
Objective: We sought to evaluate radioisotope cisternography (RICG)–related postpuncture CSF leakage by MRI.
Methods: We conducted a prospective 3-day imaging study. Ten patients with orthostatic headache and other symptoms underwent pre-RICG brain and spinal MRI, magnetic resonance myelography (MRM), RICG, and post-RICG spinal MRI and MRM. For RICG, we used a 25-gauge pencil point spinal needle at the L3/4 or L4/5 level after which subjects took bed rest for 2.5 hours.
Results: On pre-RICG MRI and MRM, none of the 10 patients showed CSF leakage. However, 5 subjects (50%) showed epidural abnormalities suggesting CSF leakage on MRI after lumbar puncture for RICG. On RICG and subsequent MRM, 4 of the subjects showed definite findings of CSF leakage and 1 showed minimal leakage.
Conclusions: RICG carries a risk of iatrogenic CSF leakage even with careful puncturing using a fine needle. This leakage produces abnormal RICG and MRM findings at the lumbosacral level. Therefore, abnormal RICG findings restricted to the lumbosacral level should be carefully interpreted when diagnosing SIH.
Footnotes
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Study funding: Supported in part by Grants-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture, Sports, Science, and Technology.
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- CI
- confidence interval
- FS
- fat-suppressed
- MR
- magnetic resonance
- MRM
- magnetic resonance myelography
- RICG
- radioisotope cisternography
- SIH
- spontaneous intracranial hypotension
- T1WI
- T1-weighted image
- T2WI
- T2-weighted image
- TSE
- turbo spin-echo
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Supplemental data at www.neurology.org.
- Received April 1, 2010.
- Accepted July 19, 2010.
- Copyright © 2010 by AAN Enterprises, Inc.
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