The intrathecal injection of gadolinium-based contrast media has been shown in several off-label studies to be effective and safe in selected patients in whom other cisternographic or myelographic studies have failed to demonstrate the CSF leak site. 1993:22[4]:718.). Fast CSF leaks have rapid contrast diffusion and may not be localized to a 2-vertebral segment of the spinal canal (suitable for local treatment by extradural blood patch or alternate therapy) by routine postmyelogram CT spine scan. Basal skull fracture should be considered in all patients with head injuries, especially those with physical signs such as otorrhea, Battle sign or periorbital ecchymoses.1 The halo or double-ring sign is a classic image in medicine and was taught as a method for determining whether bloody discharge from the ears or nose contained cerebrospinal fluid (CSF). Radionuclide cisternography in detecting cerebrospinal fluid leak in spontaneous intracranial hypotension: a series of four case reports. These are infrequently associated with CSF rhinorrhea. Various other authors, including Dohlman (1948), Hirsch (1952), and Hallberg (1964), subsequently reported successful repair of CSF rhinorrhea through different external approaches. [Full Text]. 2018 Dec;38(4):1384-1392. doi: 10.1088/1361-6498/aae39b. G-CSF-induced vasculitis has been reported to occur in 0.47% of patients.1 The double-ring sign, which reflects inflammatory changes in the adventitia and oedema of the intima, is thought to be characteristic of Takayasu arteritis (TA); however, herein, it was also observed for G-CSF-induced vasculitis.2 It is J Neurosurg. may email you for journal alerts and information, but is committed This finding is consistent with a meningoencephalocele of the temporal bone. However, the presence of a ring sign is not exclusive to CSF and can lead to false-positive results. Ultimately, a defect is formed. ISSN 1488-2329 (e) 0820-3946 (p). [QxMD MEDLINE Link]. Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases. In contrast to traumatic leaks, only 50% of patients with iatrogenic CSF leaks present within the first week after the insult. James Stankiewicz, MD Professor, Chair, Program Director, Department of Otolaryngology-Head and Neck Surgery, Loyola University Chicago School of Medicine 51(6):704, 706. Clin Radiol. Coronal fast spin-echo T2-weighted image demonstrates herniation of meninges and brain tissue (arrows) with adjacent cerebrospinal fluid into the postmastoidectomy tegmen tympani defect. Yousry I, Forderreuther S, Moriggl B, et al. With one method, the average total time for coronal and sagittal imaging is 48 minutes. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. [30] The sensitivity for CSF leaks is in the range of 50-100%. Hugh J F Robertson, MD, DMR, FRCPC, FRCR, FACR Professor Emeritus of Radiology, Louisiana State University Health Sciences Center, New Orleans; Clinical Professor of Radiology, Tulane University School of Medicine How . Other proposed mechanisms for nontraumatic CSF leaks include focal atrophy, rupture of arachnoid projections that accompany the fibers of the olfactory nerve, and persistence of an embryonic olfactory lumen. Cerebral arteriography is not used in the diagnostic imaging workup to localize the site of a CSF leak. [QxMD MEDLINE Link]. When CSF rhinorrhea is suspected, fluorescein may be injected into the lumbar subarachnoid space. Clin Nucl Med. 1993:22[4]:718.) Intermittent leakage over several years is characteristic. Meningoencephaloceles usually present in childhood as an intranasal/extranasal mass that transilluminates and expands with crying (Furstenberg sign). Nuclear cisternogram obtained at 24 hours demonstrates diffuse epidural accumulation of the tracer in the midlumbar region. Hegarty SE and Millar JS. Accessibility If a double ring sign is present, however, it is still important to make sure nothing is missed. Laryngoscope. DOUBLE HEART FILIGREE .925 Sterling SILVER Ring - 1.5g Size 7.5 Liu HS, Chen YT, Wang D, et al. Any surgical manipulation near the skull base can result in an iatrogenic CSF leak. Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine Please enable it to take advantage of the complete set of features! 52:768-770. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience. Fluid contained in the meningocele and leaked fluid in the sphenoid sinus outline the meningocele membrane. Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially devastating condition that can lead to significant morbidity and mortality for the patient. [10]. Penetrating and closed-head trauma are responsible for 90% of all cases of CSF leaks. CSF produced at the choroid plexus typically circulates from the lateral ventricles to the third ventricle via the aqueduct of Sylvius. In many cases, a CSF leak will heal on its own accord following conservative treatment, including strict bed rest, increased fluid intake and caffeine. Diagnostic ultrasound has not been useful in cranial CSF leak. Bethesda, MD 20894, Web Policies Spelle L, Boulin A, Tainturier C, Visot A, Graveleau P, Pierot L. Neuroimaging features of spontaneous intracranial hypotension. A history of headache and visual disturbances suggests increased intracranial pressure. Michael G D'Antonio, MD Associate Professor of Clinical Radiology, Department of Radiology, Section of Neuroradiology, Louisiana State University Health Sciences Center in New Orleans; Consulting Staff Radiologist, Jefferson Radiology Associate, Inc, West Jefferson Medical CenterDisclosure: Nothing to disclose.