CSF Leaks: Algorithmic Multimodality Approach

OVERVIEW
Spontaneous intracranial hypotension (SIH) is a debilitating neurological condition caused by leakage of cerebrospinal fluid (CSF) through the dura mater, the fibrous tissue that contains CSF, either through a dural defect, ruptured nerve root sleeve, or directly into a paraspinal vein (CSF venous fistula (CVF)). SIH affects the dynamics of CSF and leads to a wide range of highly disabling clinical symptoms such as orthostatic headache (head pain, pressure), nausea, vomiting, changes in vision, dizziness or vertigo, changes in hearing, ringing in the ears (tinnitus), a sense of imbalance, neck or shoulder pain, changes in cognition, and other associated neurological symptoms. Many symptoms associated with SIH are orthostatic, meaning that they are worse in the upright position and improve when lying down. Experts agree that symptoms and patient history are extremely important factors for a successful diagnosis. However, diagnosing SIH is often challenging due to the diverse range of clinical manifestations, limited findings through medical imaging, and the fact that a significant portion of patients exhibit normal results through conventional imaging. Therefore, a careful review of patient history and specialized diagnostic tests are often necessary to diagnose SIH and localize the patient’s leak.

There is increasing understanding that identifying the precise location of the CSF leakage or CVF is necessary for effective treatment of SIH. Although our understanding of SIH has increased in recent years and newer imaging techniques have improved to localize the site of a spinal CSF leak, misdiagnosis and/or underdiagnosis remain common. Additionally, some of these techniques may not be available at non-specialized medical centers, leaving numerous patients with inadequate diagnoses and treatment.

This webinar will delve into advanced myelographic imaging techniques which can be used to localize CSF leaks and CVF. We will discuss how clinical history and initial neuroimaging can provide crucial clues in discovering SIH. Additionally, seminar will provide an overview of treatment options. These insights are synthesized within an algorithmic framework, intended to guide physicians in the systematic evaluation and management of patients suspected of having SIH.