| Print Date: | May 21, 2013, 7:02 pm |
| Title | Cerebrospinal Fluid Leak |
| Text | Cerebrospinal fluid leaks are most commonly caused by trauma and surgery. 75% of traumatic leaks resolve within one week, and nearly all resolve by six months. Nontraumatic causes include congenital defects, infections, neoplasms and hydrocephalus. Leaks may occur at any site, however cribriform plate is the most susceptible to fracture and rhinorrhea. Complications of leaks include pyogenic meningitis and pneumocephalus.
Radionuclide cisternography is a highly sensitive and accurate method for detecting CSF leaks. This can be complimented with contrast CT myelogram to pinpoint the exact location and cause. Blood patch can be used to repair small spinal CSF leaks. For CSF rhinorrhea, anterior and lateral imaging is performed. For CSF otorrhea, posterior imaging is performed. Cotton nasal pledgets are placed (by otolaryngology) in the bilateral anterior and posterior nares in various locations to detect leakage from the frontal, ethmoidal and sphenoidal sinuses. The pledgets are removed usually approximately 24 hours later, yet removal after 48 and 72 hours may also occur. Individual pledget activity is counted separately in well counters, and weighed, with radioactivity normalized to gram of absorbed fluid and expressed as a ratio to milliliters of plasma. A pledget-to-plasma ratio of > 1.5 is interpreted as evidence of a CSF leak. |
| References: | Jinkins JR, et al. Intrathecal Gadolinium-enhanced MR Cisternography in the Evaluation of Clinically Suspected Cerebrospinal Fluid Rhinorrhea in Humans: Early Experience
Radiology 2002;222:555-559 Stone JA, Castillo M, et. al. Evaluation of CSF Leaks: High-Resolution CT Compared with Contrast-Enhanced CT and Radionuclide Cisternography American Journal of Neuroradiology 20:706-712 (4 1999) Lawrence SK, Sandler MP, Partain CL, and James AE, “Cerebrospinal Fluid Imaging” pp. 1163-1176 in Diagnostic Nuclear Medicine, 3rd ed. Sandler, et al. Williams and Wilkins, Baltimore, 1996. Thrall JH, et.al.Nuclear Medicine, The Requisites, 2nd ed., Lawrence SK, et.al. Diagnostic Nuclear Medicine, 3rd ed., Williams and Wilkins, Baltimore, 1996. |
| Contributor | Glenn Richard (National Naval Medical Center Bethesda) |
| Peer Reviewer | Greg Petermann (Tripler Army Medical Center) |
| Record Number | : 5579 |
| Created | 2004-03-31 09:02:41-05 |
| Modified | 2004-04-03 21:58:16-05 |
| Category: | Clinical Exam Finding or Sign |
| Location: | Brain and Neuro |
| Sublocation: | None Selected |
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