Browse > Article
http://dx.doi.org/10.3340/jkns.2020.0326

Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma  

An, Sungjae (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Jeong, Han-Gil (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Seo, Dongwook (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Jo, Hyunjun (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Lee, Si Un (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Bang, Jae Seung (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Oh, Chang Wan (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Kim, Tackeun (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.65, no.1, 2022 , pp. 13-21 More about this Journal
Abstract
Objective : Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH. Methods : All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, follow-up hematoma thickness, and follow-up mRS score. Results : Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement. Conclusion : HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies.
Keywords
Hematoma, subdural; Cerebrospinal fluid leak; Intracranial hypotension; Myelography; Magnetic resonance image; Blood patch, epidural;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Dhillon AK, Rabinstein AA, Wijdicks EF : Coma from worsening spontaneous intracranial hypotension after subdural hematoma evacuation. Neurocrit Care 12 : 390-394, 2010   DOI
2 Gordon N : Spontaneous intracranial hypotension. Dev Med Child Neurol 51 : 932-935, 2009   DOI
3 Kim J, Moon J, Kim T, Ahn S, Hwang G, Bang J, et al. : Risk factor analysis for the recurrence of chronic subdural hematoma: a review of 368 consecutive surgical cases. Korean J Neurotrauma 11 : 63-69, 2015   DOI
4 Perez-Vega C, Robles-Lomelin P, Robles-Lomelin I, Diaz-Alba A, Navarro VG : Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension - a non-reported complication. Surg Neurol Int 11 : 316, 2020   DOI
5 Schievink WI, Maya MM, Moser F, Tourje J, Torbati S : Frequency of spontaneous intracranial hypotension in the emergency department. J Headache Pain 8 : 325-328, 2007   DOI
6 Schievink WI, Maya MM, Pikul BK, Louy C : Spontaneous spinal cerebrospinal fluid leaks as the cause of subdural hematomas in elderly patients on anticoagulation. J Neurosurg 112 : 295-299, 2010   DOI
7 Hashizume K, Watanabe K, Kawaguchi M, Fujiwara A, Furuya H : Evaluation on a clinical course of subdural hematoma in patients undergoing epidural blood patch for spontaneous cerebrospinal fluid leak. Clin Neurol Neurosurg 115 : 1403-1406, 2013   DOI
8 Sayer FT, Bodelsson M, Larsson EM, Romner B : Spontaneous intracranial hypotension resulting in coma: case report. Neurosurgery 59 : E204; discussion E204, 2006   DOI
9 Tsai PH, Fuh JL, Lirng JF, Wang SJ : Comparisons between heavily T2-weighted MR and CT myelography studies in two patients with spontaneous intracranial hypotension. Cephalalgia 28 : 653-657, 2008   DOI
10 Whiteley W, Al-Shahi R, Myles L, Lueck CJ : Spontaneous intracranial hypotension causing confusion and coma: a headache for the neurologist and the neurosurgeon. Br J Neurosurg 17 : 456-458, 2003   DOI
11 Schievink WI, Maya MM, Moser FG, Tourje J : Spectrum of subdural fluid collections in spontaneous intracranial hypotension. J Neurosurg 103 : 608-613, 2005   DOI
12 Souirti Z, Benzagmout M, Belahsen F, Chaoui ME : Spontaneous bilateral subacute subdural hematoma revealing intracranial hypotension. Neurosciences (Riyadh) 14 : 384-385, 2009
13 Takahashi K, Mima T, Akiba Y : Chronic subdural hematoma associated with spontaneous intracranial hypotension: therapeutic strategies and outcomes of 55 cases. Neurol Med Chir (Tokyo) 56 : 69-76, 2016   DOI
14 Wang YF, Lirng JF, Fuh JL, Hseu SS, Wang SJ : Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension. Neurology 73 : 1892-1898, 2009   DOI
15 Yadav YR, Parihar V, Namdev H, Bajaj J : Chronic subdural hematoma. Asian J Neurosurg 11 : 330-342, 2016.   DOI
16 Yoon SH, Chung YS, Yoon BW, Kim JE, Paek SH, Kim DG : Clinical experiences with spontaneous intracranial hypotension: a proposal of a diagnostic approach and treatment. Clin Neurol Neurosurg 113 : 373-379, 2011   DOI
17 Mao YT, Dong Q, Fu JH : Delayed subdural hematoma and cerebral venous thrombosis in a patient with spontaneous intracranial hypotension. Neurol Sci 32 : 981-983, 2011   DOI
18 Ban SP, Hwang G, Byoun HS, Kim T, Lee SU, Bang JS, et al. : Middle meningeal artery embolization for chronic subdural hematoma. Radiology 286 : 992-999, 2018   DOI
19 Beck J, Hani L, Ulrich CT, Fung C, Jesse CM, Piechowiak E, et al. : Diagnostic challenges and therapeutic possibilities in spontaneous intracranial hypotension. Clin Transl Neurosci 2 : 2514183X18787371, 2018
20 Berroir S, Loisel B, Ducros A, Boukobza M, Tzourio C, Valade D, et al. : Early epidural blood patch in spontaneous intracranial hypotension. Neurology 63 : 1950-1951, 2004   DOI
21 Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, et al. : Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 259 : 449-457, 2014   DOI
22 Beck J, Gralla J, Fung C, Ulrich CT, Schucht P, Fichtner J, et al. : Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients. J Neurosurg 121 : 1380-1387, 2014   DOI
23 Chen YC, Wang YF, Li JY, Chen SP, Lirng JF, Hseu SS, et al. : Treatment and prognosis of subdural hematoma in patients with spontaneous intracranial hypotension. Cephalalgia 36 : 225-231, 2016   DOI
24 Chung SJ, Lee JH, Kim SJ, Kwun BD, Lee MC : Subdural hematoma in spontaneous CSF hypovolemia. Neurology 67 : 1088-1089, 2006   DOI
25 Dehaene S, Biesemans J, Van Boxem K, Vidts W, Sterken J, Van Zundert J : Post-dural puncture headache evolving to a subdural hematoma: a case report. Pain Pract 21 : 83-87, 2021   DOI
26 Kim BR, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS : Utility of heavily T2- weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches. J Clin Neurosci 77 : 110-115, 2020   DOI
27 Klein KM, Shiratori K, Knake S, Hamer HM, Fritsch B, Todorova-Rudolph A, et al. : Status epilepticus and seizures induced by iopamidol myelography. Seizure 13 : 196-199, 2004   DOI
28 Louhab N, Adali N, Laghmari M, Hymer WE, Ben Ali SA, Kissani N : Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture. Int J Gen Med 7 : 71-73, 2014   DOI
29 Chen HH, Huang CI, Hseu SS, Lirng JF : Bilateral subdural hematomas caused by spontaneous intracranial hypotension. J Chin Med Assoc 71 : 147-151, 2008   DOI
30 Busl KM, Prabhakaran S : Predictors of mortality in nontraumatic subdural hematoma. J Neurosurg 119 : 1296-1301, 2013   DOI
31 Ferrante E, Olgiati E, Sangalli V, Rubino F : Early pain relief from orthostatic headache and hearing changes in spontaneous intracranial hypotension after epidural blood patch. Acta Neurol Belg 116 : 503-508, 2016   DOI
32 Ferrante E, Trimboli M, Pontrelli G, Rubino F : Early coma awakening after epidural blood patch. J Clin Neurosci 71 : 295-296, 2020   DOI
33 Tsai PH, Fuh JL, Lirng JF, Wang SJ : Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a casecontrol study. Cephalalgia 27 : 929-934, 2007   DOI
34 Ferrante E, Arpino I, Citterio A, Savino A : Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in the trendelenburg position pre-medicated with acetazolamide. Clin Neurol Neurosurg 111 : 699-702, 2009   DOI
35 Frontera JA, Egorova N, Moskowitz AJ : National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007. Crit Care Med 39 : 1619-1625, 2011   DOI
36 Schievink WI : Stroke and death due to spontaneous intracranial hypotension. Neurocrit Care 18 : 248-251, 2013   DOI