CT, Postmyelogram CT, and Dynamic CT Myelogram

CT, Postmyelogram CT, and Dynamic CT Myelogram

In the a great 1995 questionnaire of your own said SS cases about industry books, a reason try understood inside the 34 from 63 circumstances. step 1 A great dural cystic is utilized in 47%. That it incorporated CSF cavity lesions (such meningocele, pseudomeningocele, pseudoencephalocele, a cavity leftover immediately after a hemispherectomy, and you may persistent suboccipital hematoma) or resources cystic (including means avulsion or epidural cyst). Tumors including ependymoma, meningioma, oligodendroglioma, pineocytoma, and paraganglioma were found in 35%, and you will vascular abnormalities instance arteriovenous malformation or aneurysm, when you look at the 18%. Inside a lately said single-business series of 29 patients, a liquid-filled collection try seen on the MR imaging from inside the fourteen. 2 In cuatro of those, the new range try rather nearby and you may advised the possibility of good meningocele or pseudomeningocele. Longitudinally comprehensive fluid-filled selections had been noticed in the others as they are a lately known connection off SS. 2,step 3,twenty eight –31,thirty six

Scientific or electrophysiologic proof all the way down engine neuron involvement try unusual for the SS however, might have been revealed and may end up being on account of arachnoiditis or radiculopathy; the latter could possibly get result from extending of courage roots by the intraspinal cysts. 17,46 –forty-two

Some patients that have SS and you will intraspinal water-occupied series have diffuse pachymeningeal improvement on postcontrast MR imaging (Fig 5A, -B). 30,31 It is identical to brand new pachymeningeal improvement observed in clients that have craniospinal hypotension, a condition also from the intraspinal water-occupied selections (Fig 9A?C1). 38 The explanation for intracranial pachymeningeal enhancement inside craniospinal hypotension try considered to be vascular dilation from inside the dura mater in the place of meningeal pain. 50 –52 An identical procedure is probably operative when it comes to those patients having SS who have a dural defect and an enthusiastic intraspinal fluid-filled range. Craniospinal hypotension could be of the RBCs regarding CSF. The presence of RBCs throughout the CSF in requirements can get getting on account of an identical procedure. The newest longitudinal liquid-filled intraspinal collection can also be care for with repair of the dural defect (Fig 6A1 and A2, B1 and B2).

A good, Sagittal T2-weighted cervicothoracic spine MR picture of an individual having intracranial hypotension suggests a great ventral extradural collection away from C6 to help you T2 (arrowhead), that’s isointense having CSF toward all the imaging sequences. B, Axial T2-weighted gradient-echo MR image from the C6–seven for the an individual having intracranial hypotension shows a great ventral extradural fluid collection broke up on the thecal sac from the a good hypointense dura (arrows). A good and you may B adjusted with consent out of B.M. Rabin. 38 C1?C3, Someone that have craniospinal hypotension who had an enthusiastic epidural pseudomeningocele brought about of the an excellent CSF problem during the T8. C1, Axial CT myelogram of the thoracic back shows the new dura marginating an enthusiastic epidural pseudomeningocele (black colored arrow). C2, Coronal reformatted CT myelogram of your own thoracic back shows a beneficial tortuous dilated posterior thoracic spinal vein (black colored arrow), similar to a beneficial dural arteriovenous fistula, and you can dura (arrowheads) separating intradural and you will epidural CSF. C3, Contrast-increased axial CT always check reveals a good dilated cervical epidural venous plexus. C1?C3 adapted having permission from J.L. Ulmer. 61

RBCs in the CSF is a defining ability out of SS

As the head otherwise back CT results are often unremarkable, cerebellar atrophy or a clue towards prospective etiology of the SS could be obvious. 53,54 Postcontrast CT in SS features barely already been associated with the widespread meningeal enhancement. 55 Evidence of bony burns off on account of early in the day stress, when the establish, may be finest viewed into CT than just into MR imaging (Fig 10B). Rarely, a great hyperattenuated rim because of calcification on web sites away from hemosiderin deposition inside the notice base tends to be seen into the CT (Fig 5C). 22

Neurology 2009;–73 (Copyright laws 2009, Wolters Kluwer Health)

An excellent, Fluid-filled intraspinal range prior towards the wire into the an enthusiastic axial slashed away from a good thoracic lower back CT myelogram. A good transdural leak ranging from C7 and you can T6 is actually introduce. A dynamic CT myelogram is also localize the specific web site of one’s problem which help direct the fresh laminectomy webpages. B, Axial CT check with bones screen of a patient having SS shows a bilaminar C7 break (just like diligent revealed into the 4C1 and you may C2). C, Axial cervical back CT myelogram shows avulsed C2 courage root, which can be directed from inside the an enthusiastic anteroposterior direction and are also seen as linear lines having nearby compare (exact same patient due to the fact one revealed into the Fig 8C). D, Dynamic CT myelogram of an individual having SS and you can a cervicothoracic epidural fluid-occupied range reveals leakage off examine through a dural split from the T1–2. 31 E1, Dynamic CT myelogram suggests leaks from contrast (arrow); the fresh new dotted arrow factors to the new intrathecal contrast. E2, Dynamic CT myelogram suggests calcified disk protrusion quickly caudal into the dural problem revealed when you look at the Elizabeth; the latest dotted arrow what to intrathecal evaluate. It diligent (E1 and you will E2) got diffuse pachymeningeal improvement, a good cervicothoracic epidural liquid range, and you may CSF RBCs and you can xanthochromia, that fixed shortly after fix of a beneficial dural defect understood from the T7–8. F1, Reformatted sagittal cuts of a working CT myelogram gotten in a diligent which have reasonable-tension headache as opposed to SS websites show a high-move CSF problem (arrow) as a result of good ventral midline problem on the right side regarding a good bilobed spiculated midline osteophyte on T2–step 3. F2, The newest osteophyte try shown on the an enthusiastic axial thoracic spine CT. Which diligent and had a beneficial ventral epidural fluid-filled range for the that your examine leaked from dural defect (dotted arrow). C reprinted having consent away from Kumar N. Superficial siderosis: contacts and you will therapeutic ramifications. Arc Neurol 2007;–96 (Copyright 2007, Western Medical Organization) and you will Kuic CT myelography in the determining the brand new etiology off superficial siderosis. Neurology 2005;–88 (Copyright laws 2005, Wolters Kluwer Fitness). E1 and you may E2 reprinted that have consent of Kumar Letter, Way JI, Piepgras DG. Superficial siderosis: securing this new problem.

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