Advanced

AJNR - American Journal of Neuroradiology

Publication Preview: Published June 26, 2008

American Journal of Neuroradiology 2008;29:1627.

This Article Full Text (PDF) All Versions of this Article: ajnr.A1157v1 29/9/1627    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Lasboo, A.A. Articles by Shaibani, A. PubMed PubMed Citation Articles by Lasboo, A.A. Articles by Shaibani, A.

American Journal of Neuroradiology
DOI 10.3174/ajnr.A1157

SPINE

Emergent Image-Guided Treatment of a Large CSF Leak to Reverse "In-Extremis" Signs of Intracranial Hypotension

A.A. Lasboo, M.C. Hurley, M.T. Walker, D. Surdell, J.K. Song, J.M. Rosenow and A. Shaibani

From the Departments of Radiology (A.A.L., M.C.H., M.T.W., D.S., A.S.) and Neurological Surgery (M.C.H., D.S., J.K.S., J.M.R., A.S.), The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Ill.

Please address correspondence to Ali Shaibani, MD, Department of Radiology, 676 North St. Clair, Suite 800, Chicago, IL 60611; e-mail: AShaibani{at}nmff.org

SUMMARY: We report the use of an emergent, targeted fibrin spinal epidural blood patch with subarachnoid saline infusion to rapidly reverse "in-extremis" clinical and imaging signs of posterior-fossa coning brought about by acute-on-chronic intracranial hypotension, itself consequent to a cervicothoracic CSF leak. Treatment resulted in a dramatic recovery and eventual discharge with return to normal lifestyle and occupation. The clinical and imaging danger signs are reviewed; fibrin patch technique and potential pitfalls in postprocedure management are analyzed.