AI Article Synopsis

  • Spontaneous intracranial hypotension (SIH) typically presents as an orthostatic headache and can be diagnosed using digital subtraction myelography (DSM) followed by lateral decubitus CT myelogram (LDCTM) for better results.
  • In a study reviewing 83 patients with negative DSM results, 11 were found to have leaks during LDCTM, with nerve sheath tears and CSF-venous fistulas being the most common types.
  • The combined approach of DSM and LDCTM improved diagnostic yield by 38.6%, leading to a positive clinical outcome in 90% of patients treated for leaks detected by LDCTM.

Article Abstract

Introduction: Spontaneous intracranial hypotension (SIH) caused by a spinal cerebrospinal fluid (CSF) leak classically presents with orthostatic headache. Digital subtraction myelography (DSM) has a well-established diagnostic yield in the absence of extradural spinal collection. At our institution, DSM is followed by lateral decubitus CT myelogram (LDCTM) in the same decubitus position to increase diagnostic yield of the combined study. We evaluated the incremental diagnostic yield of LDCTM following negative DSM and reviewed patient outcomes.

Methods: Retrospective review of consecutive DSMs with subsequent LDCTM from April 2019 to March 2021 was performed. Combined reports were reviewed, and studies with positive DSMs were excluded. Of the exams with negative DSM, only studies with LDCTM reports identifying potential leak site were included. Interventions and follow-up clinical notes were reviewed to assess symptoms improvement following treatment.

Results: Of the 83 patients with negative DSMs, 11 (13.2%) had positive leak findings on LDCTMs, and 21 (25.3%) were equivocal. Of 11 positive LDCTMs, 6 leaks were nerve sheath tears (NSTs) and 5 were CSF-venous fistulas (CVFs). 10/11 (90.9%) had intervention and follow-up, with 9/10 (90%) having positive clinical outcome. Of the 21 equivocal LDCTM patients (19 CVFs and 2 NSTs), 15 (71.4%) had interventions and follow-up, with 3/15 (20.0%) with positive clinical outcomes.

Conclusion: LDCTM following negative DSM has an incremental diagnostic yield up to 38.6%, with up to 14.5% of positive patient outcomes following treatment. LDCTM should be considered after DSM to maximize diagnostic yield of the combined exam.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569200PMC
http://dx.doi.org/10.1177/19714009231173110DOI Listing

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