Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report
| العنوان: | Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report |
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| المؤلفون: | Yoshitaka Ito, Tsuyoshi Maeda, Hideki Bandai, Madoka Nakajima, Keisuke Yamaguchi, Masakazu Miyajima, Chihiro Akiba |
| المصدر: | BMC Neurology, Vol 20, Iss 1, Pp 1-5 (2020) BMC Neurology |
| بيانات النشر: | BMC, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, medicine.medical_treatment, Spinal canal stenosis, lcsh:RC346-429, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Spinal Stenosis, Case report, C1-C2 sign, medicine, Humans, Spinal canal, Intracranial Hypotension, lcsh:Neurology. Diseases of the nervous system, Cerebrospinal fluid leak, business.industry, General Medicine, Middle Aged, medicine.disease, Laminoplasty, Magnetic Resonance Imaging, Epidural space, Stenosis, medicine.anatomical_structure, Hematoma, Subdural, Cervical Vertebrae, Drainage, Neurology (clinical), Radiology, business, Spinal Canal, Intracranial hypotension, 030217 neurology & neurosurgery |
| الوصف: | 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. |
| اللغة: | English |
| تدمد: | 1471-2377 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b8e22108c85c0b14b69c0237597f1703 http://link.springer.com/article/10.1186/s12883-020-01697-1 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....b8e22108c85c0b14b69c0237597f1703 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 14712377 |
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