Incidental asymptomatic spinal cerebrospinal fluid leaks: single-center experience, and a presentation of seven cases
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View abstract on PubMed
Summary
This summary is machine-generated.A small percentage of patients with spontaneous intracranial hypotension (SIH) show no symptoms. These asymptomatic spinal cerebrospinal fluid (CSF) leaks can still lead to complications and may represent a presymptomatic stage.
Area Of Science
- Neurology
- Radiology
- Neurosurgery
Background
- Spontaneous intracranial hypotension (SIH) typically presents with symptoms.
- The prevalence of asymptomatic SIH has not been previously defined.
- This study investigates asymptomatic cases identified via brain MRI at a single institution.
Purpose Of The Study
- To determine the rate of asymptomatic SIH in patients with high/intermediate Bern scores.
- To identify the causes, complications, and treatment outcomes of asymptomatic SIH.
- To explore the potential for a presymptomatic phase of spinal cerebrospinal fluid (CSF) leaks.
Main Methods
- Retrospective analysis of 81 patients with confirmed CSF leaks and high/intermediate Bern scores from Sept 2020 to July 2023.
- Exclusion of iatrogenic leaks and patients without brain MRI.
- Review of asymptomatic patients' charts for MRI indications, SIH progression, complications, leak type, and treatment outcomes.
Main Results
- 8.6% (7/81) of patients with high/intermediate Bern scores were asymptomatic at initial imaging.
- Four of seven asymptomatic patients had CSF-venous fistulas, treated successfully with embolization.
- Complications observed in asymptomatic leaks included subdural hematoma and superficial siderosis.
Conclusions
- Asymptomatic spinal CSF leaks are not rare and may indicate a presymptomatic phase of SIH.
- Myelography effectively identified leak etiology in this cohort.
- Targeted treatment led to prompt radiographic improvement in asymptomatic leaks.
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