PMC4524007_01
Sagittal magnetic resonance imaging of the brain with gadolinium demonstrates diffuse, smooth enhancement of the pachymeninges suggestive of meningeal hyperemia and intracranial hypotension
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F1
Diffuse smooth pachymeningeal enhancement over the cerebral convexities was consistent with meningeal hyperemia and intracranial hypotension [Figure 1].
Computed tomography (CT) of the cervical spine following intrathecal administration of contrast. (a) Sagittal and (b) axial CT demonstrates contrast anterior to the cervical thecal sac. This collection is attenuated in comparison to the intra-dural contrast. The presence of this ventral epidural fluid collection suggests cerebrospinal fluid-contrast egress
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F2
CTM of the entire spinal axis demonstrated a subtly enhancing epidural fluid collection anterior to the cervical spinal cord [Figure 2].
Static nuclear medicine cerebrospinal cisternography following injection of indium-111-diethyl-enetriamine-penta-acetic acid. (a) Right and (b) left lateral initial static images as well as (c) 5 min delayed images were obtained following administration of radiotracer. No evidence of abnormal accumulation of radioisotope is seen with initial or delayed injections. A photopenic region is demonstrated in the mid-cervical spine suggesting extrinsic pressure on the cervical subarachnoid space and corresponding to the epidural fluid collection seen on computed tomography myelography
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F3
Immediate postinjection static images revealed a photopenic region in the mid-cervical spine likely attributable to the extradural fluid accumulation seen on CTM [Figure 3].
Dynamic nuclear medicine cerebrospinal cisternography following pressurized injection of saline through the lumbar drain. (a) Right and (b) left lateral views are obtained at the time of pressurized saline injection. Evidence of an abnormal accumulation of radioisotope is seen dorsally at C1-2 on both views
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F4
Extravasation of radiotracer was seen dorsally at C1-2 [Figure 4].