Iatrogenic CSF Leak from CT Myelogram Leading to Cauda Equina Compression: A Case Report.
Martinus Megalla1, Alexander P Decilveo2, Robert M McCunney2
1Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey.
Journal of Orthopaedic Case Reports
|March 6, 2023
Summary
Computerized tomography (CT) myelogram can diagnose cauda equina syndrome (CES) but carries a risk of cerebrospinal fluid (CSF) leak. This case highlights a rare instance where a CT myelogram led to CSF leak and recurrent CES.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Magnetic resonance imaging (MRI) is the gold standard for diagnosing cauda equina syndrome (CES).
- Computerized tomography (CT) myelogram serves as an alternative imaging modality for patients unable to undergo MRI.
- CT myelogram carries a theoretical risk of cerebrospinal fluid (CSF) leak, potentially leading to CES.
Observation:
- A 38-year-old male patient presented with CES and underwent surgical decompression.
- Post-operatively, the patient developed an iatrogenic CSF leak secondary to a pre-operative CT myelogram.
- This complication resulted in recurrent thecal sac compression, necessitating further surgical intervention and dural repair.
Findings:
- This case report details a rare complication of CT myelogram: iatrogenic CSF leak causing recurrent thecal sac compression.
- The patient required repeat surgery for dural repair to address the CSF leak and associated CES.
- This represents the first reported instance of CT myelogram-induced cauda equina compression.
Implications:
- Clinicians should consider the risk of CSF leak when performing CT myelograms for CES diagnosis.
- Careful needle placement and post-procedure monitoring are crucial to mitigate iatrogenic CSF leak risks.
- This case underscores the importance of evaluating alternative diagnostic pathways and potential complications in managing CES.
