Radionuclide cisternography in spontaneous intracranial hypotension with simultaneous leaks at the cervicothoracic and lumbar levels

This case report clearly illustrates defined simultaneous cerebrospinal flu id leaks at the cervicothoracic and upper lumbar areas. A 53-year-old woman without a remarkable medical history was hospitalized for sudden onset of severe headache. The headache lasted more than 1 week and standing or sitti ng positions exaggerated the symptoms, although it was relieved when the pa tient was recumbent. Radionuclide cisternography was performed using 150 MB q (4 mCi) Tc-99m DTPA. It revealed two cerebrospinal fluid leaks from the c ervicothoracic junction bilaterally and the left side of the upper lumbar a rea. Epidural blood patching was tried at the lumbar level (L1-L2) and show ed only a transient effect. A second trial of this method at the level of C 7-T1 performed 2 days later resulted in immediate improvement of the sympto ms without recurrence. The simultaneous cerebrospinal fluid leaks were dete cted successfully with radionuclide cisternography using Tc-99m DTPA, which provided a useful guideline for treatment despite the limitations of delay ed scanning.