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Slow CSF Leak/CSF Venous Fistula
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Spontaneous intracranial hypotension (SIH)
            • Definitions

              • Direct connection between spinal subarachnoid space and paraspinal vein that permits unregulated loss of CSF
                • Slow leak so usually no epidural fluid present

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Chan SM et al: Intracranial hypotension and cerebrospinal fluid leak. Neuroimaging Clin N Am. 29(2):213-26, 2019
                                  2. Dobrocky T et al: Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol. 76(5):580-7, 2019
                                  3. Dobrocky T et al: Cryptogenic cerebrospinal fluid leaks in spontaneous intracranial hypotension: role of dynamic CT myelography. Radiology. 289(3):766-72, 2018
                                  4. Kranz PG et al: CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography. AJR Am J Roentgenol. 209(6):1360-6, 2017
                                  5. Kranz PG et al: Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension. AJR Am J Roentgenol. 206(1):8-19, 2016
                                  6. Schievink WI et al: A classification system of spontaneous spinal CSF leaks. Neurology. 87(7):673-9, 2016
                                  7. Mokri B: Spontaneous intracranial hypotension. Continuum (Minneap Minn). 21(4 Headache):1086-108, 2015
                                  8. Schievink WI et al: CSF-venous fistula in spontaneous intracranial hypotension. Neurology. 83(5):472-3, 2014
                                  9. Akbar JJ et al: The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 33(3):535-40, 2012
                                  10. Schievink WI et al: False localizing sign of C1-2 cerebrospinal fluid leak in spontaneous intracranial hypotension. J Neurosurg 100:639-44, 2004
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Spontaneous intracranial hypotension (SIH)
                                            • Definitions

                                              • Direct connection between spinal subarachnoid space and paraspinal vein that permits unregulated loss of CSF
                                                • Slow leak so usually no epidural fluid present

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Staging, Grading, & Classification

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Chan SM et al: Intracranial hypotension and cerebrospinal fluid leak. Neuroimaging Clin N Am. 29(2):213-26, 2019
                                                                  2. Dobrocky T et al: Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol. 76(5):580-7, 2019
                                                                  3. Dobrocky T et al: Cryptogenic cerebrospinal fluid leaks in spontaneous intracranial hypotension: role of dynamic CT myelography. Radiology. 289(3):766-72, 2018
                                                                  4. Kranz PG et al: CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography. AJR Am J Roentgenol. 209(6):1360-6, 2017
                                                                  5. Kranz PG et al: Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension. AJR Am J Roentgenol. 206(1):8-19, 2016
                                                                  6. Schievink WI et al: A classification system of spontaneous spinal CSF leaks. Neurology. 87(7):673-9, 2016
                                                                  7. Mokri B: Spontaneous intracranial hypotension. Continuum (Minneap Minn). 21(4 Headache):1086-108, 2015
                                                                  8. Schievink WI et al: CSF-venous fistula in spontaneous intracranial hypotension. Neurology. 83(5):472-3, 2014
                                                                  9. Akbar JJ et al: The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 33(3):535-40, 2012
                                                                  10. Schievink WI et al: False localizing sign of C1-2 cerebrospinal fluid leak in spontaneous intracranial hypotension. J Neurosurg 100:639-44, 2004