PMC4533466_01
Spinal T2-weighted magnetic resonance (MR) imaging on admission revealed the presence of cerebellar tonsil descensus (8 mm below the foramen magnum) and syringomyelia in the spinal cord, from C3 to Th7 (A). Brain coronal and sagittal T1-weighted MR images with gadolinium did not reveal pachymeningeal enhancement, brain sagging, or subdural fluid collection (B, C).
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F1
Spinal MRI revealed that her cerebellar tonsil was descended by 8 mm from the foramen magnum, with syringomyelia formation from C3 to Th7 (Fig. 1A). There were neither traumatic changes nor brain sagging or subdural fluid collection (Fig. 1B, C).
Sequential images of radioisotope (RI) cisternography were acquired at 1 h (A), 4 h (B), 6 h (C), and 24 h (D) after injection. Early accumulation of RI was observed in the bladder, and a delayed accumulation of RI was observed in the cerebral fornix.
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F2
CSF leakage (Fig. 2). CSF pressure measured at the time of the performance of lumbar puncture for RI cisternography was 10 cmH2O.
Gd-enhanced magnetic resonance (MR) cisternography revealed that the contrast medium was leaking from the left side of the L4-5 area (arrow).
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F3
Gd-contrast medium (0.5 mL Gd-contrast medium + 4 mL saline) was injected into the subarachnoid space from the lumbar spine; (2) the patient stayed in an elbow-to-knee position for 15 min, and then in a supine position for another hour before; and (3) whole-spine MRI was performed. Gd-enhanced MR cisternography revealed that the contrast medium was leaking from the left side of the L4-5 area (Fig. 3).
T2-weighted magnetic resonance imaging performed 2 years after epidural blood patch revealed the presence of cerebellar tonsil descensus and syringomyelia in the spinal cord.
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F4
MRI performed 2 years after EBP showed no change in the degree of cerebellar tonsil descensus or syringomyelia (Fig. 4).