Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
Abstract Background Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. Met...
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12883-020-01740-1 |
| _version_ | 1811214894298562560 |
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| author | Tommy Lik Hang Chan Robert Cowan Nada Hindiyeh Syed Hashmi Bryan Lanzman Ian Carroll |
| author_facet | Tommy Lik Hang Chan Robert Cowan Nada Hindiyeh Syed Hashmi Bryan Lanzman Ian Carroll |
| author_sort | Tommy Lik Hang Chan |
| collection | DOAJ |
| description | Abstract Background Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. Methods This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. Targeted epidural patches with fibrin sealant were performed. Treatment response at return visit (3 months post-patch) was documented. Results Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity. Conclusion Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site. |
| first_indexed | 2024-04-12T06:13:08Z |
| format | Article |
| id | doaj.art-beae3447cb494924bb48d42b1ee53310 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-12T06:13:08Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-beae3447cb494924bb48d42b1ee533102022-12-22T03:44:39ZengBMCBMC Neurology1471-23772020-04-012011710.1186/s12883-020-01740-1Spinal cerebrospinal fluid leak in the context of pars interarticularis fractureTommy Lik Hang Chan0Robert Cowan1Nada Hindiyeh2Syed Hashmi3Bryan Lanzman4Ian Carroll5Division of Headache and Facial Pain, Department of Neurology & Neurological Sciences, Stanford UniversityDivision of Headache and Facial Pain, Department of Neurology & Neurological Sciences, Stanford UniversityDivision of Headache and Facial Pain, Department of Neurology & Neurological Sciences, Stanford UniversityDepartment of Rad/Neuroimaging and Neurointervention, Stanford UniversityDepartment of Rad/Neuroimaging and Neurointervention, Stanford UniversityDepartment of Anesthesia, Stanford UniversityAbstract Background Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. Methods This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. Targeted epidural patches with fibrin sealant were performed. Treatment response at return visit (3 months post-patch) was documented. Results Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity. Conclusion Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site.http://link.springer.com/article/10.1186/s12883-020-01740-1Spinal cerebrospinal fluid leakSpinal CSF leakIntracranial hypotensionPars interarticularis fracture |
| spellingShingle | Tommy Lik Hang Chan Robert Cowan Nada Hindiyeh Syed Hashmi Bryan Lanzman Ian Carroll Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture BMC Neurology Spinal cerebrospinal fluid leak Spinal CSF leak Intracranial hypotension Pars interarticularis fracture |
| title | Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture |
| title_full | Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture |
| title_fullStr | Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture |
| title_full_unstemmed | Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture |
| title_short | Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture |
| title_sort | spinal cerebrospinal fluid leak in the context of pars interarticularis fracture |
| topic | Spinal cerebrospinal fluid leak Spinal CSF leak Intracranial hypotension Pars interarticularis fracture |
| url | http://link.springer.com/article/10.1186/s12883-020-01740-1 |
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