Spinal Cerebrospinal Fluid Leak in the context of Pars Interarticularis Fracture: A Case Series
Year: 2020
Type: preprint
Study design: Case Report
Abstract: Introduction: Spinal Cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. Methods: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated at the Stanford CSF leak headache clinic between January 2016 and September 2019. All cases were presented at the combined neuroradiology/headache neurology CSF leak conference. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. All targeted epidural patches with fibrin sealant were performed by a team member board-certified in Headache, Anesthesiology, and Pain Medicine. Treatment response at return visit (3 months post patch) was reported based on a pain intensity scale from 0 to 10, 10 being the most severe. Results: Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of onset of headache was 39 years old, ranges from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity. Conclusion: Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site.
Institution: Stanford University
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4254001370