A case of Radionuclide Cisternography in Spontaneous Intracranial Hypotension with multiple leaks

Abstract

Spontaneous intracranial hypotension is characterized by postural headache, low CSF pressure, and specific MRI findings. The pathogenic mechanism of spontaneous intracranial hypotension has suggested spontaneous cerebrospinal fluid leakage from a spinal dural tear without previous history of head trauma or lumbar puncture. Most common site of CSF leakage was C-T spine junction, almost all cases were single or double lesion and multiple leaks were very rare. Case : A 35-years-old man complaint headache. The character of headache was orthostatic and associated with severe nausea, vomiting. The headache was not relieved by analgesics. He had no history of trauma or lumbar puncture. Neurological examination showed no lateralizing and localizing sign. Brain MRI demonstrated diffuse thickening and enhancement of the meninges. No signs of venous sinus thrombosis were identified. There was no downward displacement of the cerebellar tonsils. The radionuclide cisternography showed cerebrospinal fluid leakage at both C-T junction level and multiple thoracic spine levels. After epidural blood patch was performed twice, his symptom was improved