PMC5234307_01
(a) Magnetic resonance imaging (MRI) of the cervical spine (T2-weighted sagittal image) obtained shortly following neck injury, which was considered within the normal range. (b) MRI of the cervical spine (T2-weighted sagittal image) at the time of admission, showing decreased cerebrospinal fluid (CSF) space. The increase in the thickness of the retro-odontoid tissue was also noted (asterisk). (c) Heavily T2-weighted MRI showing the accumulation of extradural CSF in the paraspinal tissue at C1-2 (arrow)
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F1
MRI of the cervical spine (T2-weighted sagittal image) obtained shortly after the injury was considered within the normal range [Figure 1a]. MRI with gadolinium established the diagnosis through the identification of a diffuse duromeningeal enhancement on the axial T1-weighted image and the pituitary gland on the sagittal T1-weighted image. MRI of the cervical spine (T2-weighted sagittal image) revealed a decrease in the CSF space of the cervical spine compared with the previous MRI [Figure 1a and b]. A mild increase in the thickness of the retro-odontoid soft tissue was noted [Figure 1a and b]. The accumulation of extradural CSF in the paraspinal tissue at C1-2 was also shown in the heavily T2-weighted MRI [Figure 1c].
Computed tomography myelogram obtained following admission, showing massive leakage of contrast medium at C1-2 of the left side (a, axial view; b, sagittal view). At two weeks post-surgery, no leakage of contrast medium was observed (c, axial view; d, sagittal view)
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F2
A CT myelogram, obtained 1 hour following the intrathecal injection of contrast material, revealed a massive CSF leakage at C1-2 [Figure 2a and b]. A repeat CT myelogram was obtained 14 days after surgery, which revealed no CSF leakage [Figure 2c and d], and she was discharged 20 days after admission.
Time-spatial labeling inversion pulse MRI showing the CSF flow dynamics. a/c, axial view; b/d, sagittal view. Compared with a/b, CSF leakage was observed in the C1-2 epidural space (circled) in c/d (c/d scanned 2.7 seconds after a/b)
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F3
With the cinematically reconstructed T-SLIP MRI [Supplementary video 1], the CSF outflow into the C1-2 epidural space on the left side was observed [Figure 3a-d].