Interactive Radiology Case Reports :: Supine Digital Subtraction Myelography for the Demonstration of a Dorsal Cerebrospinal Fluid Leak in a Patient with Spontaneous Intracranial Hypotension: A Technical Note

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal T1-weighted MRI (1.5 Tesla magnet; TR, 517 msec; TE, 9 msec; 7.7 ml Magnevist) images with contrast of the head demonstrates caudal displacement of the cerebellar tonsils (short arrow) and slight flattening of the anterior pons (thick arrow).

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Coronal T1-weighted MRI (1.5 Tesla magnet; TR, 517 msec; TE, 9 msec; 7.7 ml Magnevist) images shows diffuse pachymeningeal enhancement.

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal FIR MRI (1.5 Tesla magnet; TR, 9,730 msec; TE, 35 msec) images of the cervical and upper thoracic spine shows high T2 extra-dural collections ventrally from C2 to T12 and dorsally from C7 to T8.

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal FIR MRI (1.5 Tesla magnet; TR, 6,206 msec; TE, 37 msec) images of the lower thoracic and lumbar spine delineates the lower aspect of the extradural collections in the upper spinal canal and an additional dorsal collection from T9 to L2.

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Axial post-myelography CT (10 cc Omnipaque 300 intrathecal; 64 slice GE Lightspeed scanner; 120 kVp; 200 mA; 5 mm slice thickness) images showing extrathecal contrast, confirming the presence of an active CSF leak.

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal post-myelography CT (10 cc Omnipaque 300 intrathecal; 64 slice GE Lightspeed scanner; 120 kVp; 200 mA; 5 mm slice thickness) images showing extrathecal contrast, confirming the presence of an active CSF leak.

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Lateral projection, sequence of images from a digital subtraction myelogram (8 cc intrathecal Omnipaque 300) performed with the patient in the supine position as contrast was injected through a lumbar drain. Active contrast extravasation at T9-10 (arrows) confirms the dorsal location of the leak.

Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Coronal projection, sequence of images from a digital subtraction myelogram (8 cc intrathecal Omnipaque 300) performed with the patient in the supine position as contrast was injected through a lumbar drain. Active contrast extravasation at T9-10 (arrows) confirms the dorsal location of the leak.


Series 1 Series 2 Series 3 Series 4 Series 5 Series 6 Series 7 Series 8 Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal T1-weighted MRI (1.5 Tesla magnet; TR, 517 msec; TE, 9 msec; 7.7 ml Magnevist) images with contrast of the head demonstrates caudal displacement of the cerebellar tonsils (short arrow) and slight flattening of the anterior pons (thick arrow). Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Coronal T1-weighted MRI (1.5 Tesla magnet; TR, 517 msec; TE, 9 msec; 7.7 ml Magnevist) images shows diffuse pachymeningeal enhancement. Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal FIR MRI (1.5 Tesla magnet; TR, 9,730 msec; TE, 35 msec) images of the cervical and upper thoracic spine shows high T2 extra-dural collections ventrally from C2 to T12 and dorsally from C7 to T8. Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal FIR MRI (1.5 Tesla magnet; TR, 6,206 msec; TE, 37 msec) images of the lower thoracic and lumbar spine delineates the lower aspect of the extradural collections in the upper spinal canal and an additional dorsal collection from T9 to L2. Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Axial post-myelography CT (10 cc Omnipaque 300 intrathecal; 64 slice GE Lightspeed scanner; 120 kVp; 200 mA; 5 mm slice thickness) images showing extrathecal contrast, confirming the presence of an active CSF leak. Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Sagittal post-myelography CT (10 cc Omnipaque 300 intrathecal; 64 slice GE Lightspeed scanner; 120 kVp; 200 mA; 5 mm slice thickness) images showing extrathecal contrast, confirming the presence of an active CSF leak. Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Lateral projection, sequence of images from a digital subtraction myelogram (8 cc intrathecal Omnipaque 300) performed with the patient in the supine position as contrast was injected through a lumbar drain. Active contrast extravasation at T9-10 (arrows) confirms the dorsal location of the leak. Click 34 year old male patient with spontaneous intracranial hypotension due to a dorsal cerebrospinal fluid (CSF) leak. Coronal projection, sequence of images from a digital subtraction myelogram (8 cc intrathecal Omnipaque 300) performed with the patient in the supine position as contrast was injected through a lumbar drain. Active contrast extravasation at T9-10 (arrows) confirms the dorsal location of the leak.