PMC6165595_01
Sagittal and axial CT lumbar myelogram images show a focal CSF leak from the posterolateral aspect of the thecal sac at L3-L4 level, with iodinated contrast accumulating posterior to the thecal sac (red arrows).
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On experiencing new onset persistent headaches on the second postoperative day, a computerized tomography (CT) myelogram was performed, and showed CSF leakage from a dural tear at the L3-L4 level (Figure 1).
Nonenhanced CT head image at the level of the cerebellum demonstrates acute haemorrhages in both cerebellar hemispheres (arrow) with edema, causing mass effect on the fourth ventricle.
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The CT scan revealed areas of acute haemorrhage in both cerebellar hemispheres, with mass effect on the fourth ventricle and the brainstem and mild obstructive hydrocephalus (Figure 2).
MRI brain was performed on the same date of the CT head. It confirmed cerebellar haemorrhage and mass effect on the 4th ventricle and brainstem. (a) Axial T1 SPGR postgadolinium MR image shows diffuse dural enhancement. (b) Sagittal T1 MR image of the brain shows "sagging" midbrain, flattening of the pons against the clivus, and mild cerebellar tonsillar descent. The findings in (a) and (b) are consistent with intracranial hypotension.
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MRI scanning of the brain, with and without contrast, revealed evidence of intracranial hypotension (Figure 3).