Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report
Abstract Background Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intr...
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Neurology |
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| Online Access: | http://link.springer.com/article/10.1186/s12883-020-01697-1 |
| _version_ | 1818684633439535104 |
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| author | Chihiro Akiba Hideki Bandai Yoshitaka Ito Tsuyoshi Maeda Keisuke Yamaguchi Madoka Nakajima Masakazu Miyajima |
| author_facet | Chihiro Akiba Hideki Bandai Yoshitaka Ito Tsuyoshi Maeda Keisuke Yamaguchi Madoka Nakajima Masakazu Miyajima |
| author_sort | Chihiro Akiba |
| collection | DOAJ |
| description | Abstract Background Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. Case presentation A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3–4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively. Conclusion The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension. |
| first_indexed | 2024-12-17T10:53:44Z |
| format | Article |
| id | doaj.art-ceb19cc0b24940f7b758c5ca0f474730 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-17T10:53:44Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-ceb19cc0b24940f7b758c5ca0f4747302022-12-21T21:51:53ZengBMCBMC Neurology1471-23772020-04-012011510.1186/s12883-020-01697-1Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case reportChihiro Akiba0Hideki Bandai1Yoshitaka Ito2Tsuyoshi Maeda3Keisuke Yamaguchi4Madoka Nakajima5Masakazu Miyajima6Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical CenterDepartment of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical CenterDepartment of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical CenterDepartment of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical CenterDepartment of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical CenterDepartment of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical CenterDepartment of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical CenterAbstract Background Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. Case presentation A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3–4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively. Conclusion The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension.http://link.springer.com/article/10.1186/s12883-020-01697-1Case reportCerebrospinal fluid leakC1-C2 signIntracranial hypotensionSpinal canal stenosis |
| spellingShingle | Chihiro Akiba Hideki Bandai Yoshitaka Ito Tsuyoshi Maeda Keisuke Yamaguchi Madoka Nakajima Masakazu Miyajima Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report BMC Neurology Case report Cerebrospinal fluid leak C1-C2 sign Intracranial hypotension Spinal canal stenosis |
| title | Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report |
| title_full | Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report |
| title_fullStr | Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report |
| title_full_unstemmed | Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report |
| title_short | Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report |
| title_sort | cerebrospinal fluid leak presented with the c1 c2 sign caused by spinal canal stenosis a case report |
| topic | Case report Cerebrospinal fluid leak C1-C2 sign Intracranial hypotension Spinal canal stenosis |
| url | http://link.springer.com/article/10.1186/s12883-020-01697-1 |
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