Technical review and considerations for a cerebrospinal fluid leakage study

Within the past decade, published diagnostic algorithms for cerebrospinal fluid (CSF) leakage have included beta-2-transferrin analysis, rigid nasal endoscopy, high-resolution CT, CT cisternography, CT fluorescein lumbar puncture, and MRI but have not included the nuclear medicine CSF leakage study. However, some physicians still use this study today. This case report reviews the procedure and data calculations for the study. The presented case demonstrates how patient ingenuity in maintaining a compromised pledget for counting after sneezing contributed to the final diagnostic outcome. The patient was a 58-y-old man who presented with persistent nasal drainage and headaches, with no history of previous head trauma or surgery. The patient was referred to the nuclear medicine department for a CSF leakage study, which had positive findings and led to a final diagnosis of a large dural and skull defect posteriorly over the ethmoid sinuses.