Ventral intraspinal fluid-filled collection secondary to CSF leak presenting as bibrachial amyotrophy
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MRI has identified a broader clinical spectrum of CSF leaks than what was initially recognized. Although headache, particularly orthostatic, is the most common manifestation, most patients display additional symptoms, and some have no headaches.1,2 Other manifestations include cochleovestibular and oculomotor disturbances, cognitive impairment, interscapular pain, and imbalance.1,2 This report draws attention to yet another manifestation of CSF leaks: segmental amyotrophy related to cervical cord compromise from an intraspinal ventral epidural fluid-filled collection in communication with the subarachnoid space. The 3 reported patients showed clinical improvement after dural defect repair; imaging resolution of the intraspinal fluid-filled collection was demonstrated in all.
Case reports.
Case 1.
A 48-year-old man presented with a 5-year history of progressive, bilateral, asymmetric, proximal greater than distal, upper limb atrophy and weakness. EMG demonstrated chronic neurogenic changes in the C4–C8 myotomes. MRI showed a ventral extradural intraspinal fluid-filled collection from C2 to L4 with posterior displacement and flattening of the cord from C3–C7 (figure, A1 and A2). A dural defect was identified on a dynamic CT myelogram at T12–L1 (figure, A3); this was surgically closed. At 6-month follow-up, significant clinical improvement was noted; this was accompanied by complete resolution of the imaging abnormality (figure, A4 and A5).
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