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Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture

BACKGROUND: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. METHODS: Th...

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Autores principales: Chan, Tommy Lik Hang, Cowan, Robert, Hindiyeh, Nada, Hashmi, Syed, Lanzman, Bryan, Carroll, Ian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191704/
https://www.ncbi.nlm.nih.gov/pubmed/32349710
http://dx.doi.org/10.1186/s12883-020-01740-1
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author Chan, Tommy Lik Hang
Cowan, Robert
Hindiyeh, Nada
Hashmi, Syed
Lanzman, Bryan
Carroll, Ian
author_facet Chan, Tommy Lik Hang
Cowan, Robert
Hindiyeh, Nada
Hashmi, Syed
Lanzman, Bryan
Carroll, Ian
author_sort Chan, Tommy Lik Hang
collection PubMed
description BACKGROUND: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. METHODS: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. Targeted epidural patches with fibrin sealant were performed. Treatment response at return visit (3 months post-patch) was documented. RESULTS: Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity. CONCLUSION: Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site.
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spelling pubmed-71917042020-05-04 Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture Chan, Tommy Lik Hang Cowan, Robert Hindiyeh, Nada Hashmi, Syed Lanzman, Bryan Carroll, Ian BMC Neurol Research Article BACKGROUND: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. METHODS: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. Targeted epidural patches with fibrin sealant were performed. Treatment response at return visit (3 months post-patch) was documented. RESULTS: Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity. CONCLUSION: Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site. BioMed Central 2020-04-29 /pmc/articles/PMC7191704/ /pubmed/32349710 http://dx.doi.org/10.1186/s12883-020-01740-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Chan, Tommy Lik Hang
Cowan, Robert
Hindiyeh, Nada
Hashmi, Syed
Lanzman, Bryan
Carroll, Ian
Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
title Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
title_full Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
title_fullStr Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
title_full_unstemmed Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
title_short Spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
title_sort spinal cerebrospinal fluid leak in the context of pars interarticularis fracture
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191704/
https://www.ncbi.nlm.nih.gov/pubmed/32349710
http://dx.doi.org/10.1186/s12883-020-01740-1
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