Whole-spine MRM was performed with 3-dimensional sampling perfection and optimized contrast using variable flip-angle evolution (3D-SPACE) sequences. Three-dimensional volumetric interpolated breath-hold examination and Gd-enhanced T1WI focusing on C-T spine level were also obtained to determine if spinal epidural venous engorgement was present. Conventional brain MRI included axial spin-echo T1WI (repetition time (TR)/ echo time (TE), 500/10), axial fast spin-echo T2-weighted images (TR/TE 3200/115), and Gd-enhanced spin-echo T1WI images in the axial, sagittal, and coronal planes. All patients received whole-spine MRM and spine and conventional brain MRI simultaneously upon presentation. NeuroimagingĪ 1.5-T MRI scanner (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) was used. The etiology, age at symptom onset, sex, headache score measurement using the visual analogue scale upon presentation, duration between symptom onset and MRI examination (onset–diagnosis interval), and hospitalization duration were collected from medical records for analysis. In this study, we identified the risk factors for patients with spinal CSF leakage who were nonresponsive to hydration. These patients usually experience longer hospitalizations and may have a higher risk of complications. However, the risk factors for patients who are nonresponsive to hydration and require further EBP are unclear. Evaluation of treatment response relies on the improvement of clinical symptoms. Patients who are nonresponsive to hydration require an epidural blood patch (EBP). Intensive intravenous hydration is the standard treatment for symptomatic spinal CSF leakage. Īlthough patients can spontaneously recover after bed rest, SDH with brain herniation or sinus thrombosis are severe complications if the disease is not recognized and treated. Patients may also have abnormal fluid accumulation at the C1–2 junction and epidural venous plexus engorgement on a spinal MRI. Diffused pachymeningeal enhancement, pituitary hyperemia, dural sinus engorgement, brain descent, subdural effusion, and subdural hematoma (SDH) are common radiological findings on brain magnetic resonance imaging (MRI) in patients with CSF leakage. A definitive diagnosis relies on standard radiological findings definitive CSF leakage can be determined using spinal magnetic resonance myelography (MRM) to indicate abnormal spinal CSF signals along spinal neural sleeves or the accumulation of abnormal CSF in the epidural space. The possibility of spinal CSF leakage must be carefully excluded in patients with orthostatic headaches. The major etiologies include post-dural puncture headache (PDPH) or a spontaneous event, with incidences of approximately 12–40% and 0.05%, respectively. Spinal cerebrospinal fluid (CSF) leakage is usually encountered in clinical settings. EBP should be considered early in these patients. Patients with spinal CSF leakage who have spontaneous intracranial hypotension and those with ≥9 spinal CSF leakages are considered at risk for noneffective hydration. Spontaneous intracranial hypotension (odds ratio : 4.63 95% confidence interval : 1.00-21.38) and having ≥9 spinal CSF leakages (OR: 3.29 95% CI: 1.08-10.01), as indicated by magnetic resonance myelography, are considered risk factors for noneffective hydration. 8.04, P = 0.01), and had a higher percentage of dural sinus engorgement (81.63% vs. 34.32 years, P = 0.01), had a higher percentage of spontaneous intracranial hypotension (93.88% vs. Patients who were nonresponsive to hydration were older (39.27 vs. Of the 74 patients with spinal CSF leakage, 25 were responsive to hydration and 49 required EBP. Clinical data, including patient age, sex, etiology, and radiological indications in magnetic resonance imaging, were compared between patients who were responsive and non-responsive to hydration. We retrospectively reviewed patients diagnosed with spinal CSF leakage between January 2010 and March 2021. Therefore, we identified the risk factors for patients with spinal CSF leakage nonresponsive to hydration. The risks of nonresponsive hydration remain unknown. Although some patients recover without treatment or after intensive hydration, some require an epidural blood patch (EBP). Spinal cerebrospinal fluid (CSF) leakage is frequently encountered clinically after lumbar puncture or spontaneous events.
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