Superficial siderosis associated with an iatrogenic posterior fossa dural leak identified on CT cisternography

Superficial siderosis refers to hemosiderin deposition along the pial surface of the brain and spinal cord. It results from chronic and repetitive low-grade bleeding into the subarachnoid space. Dural tears are a common cause of superficial siderosis. Although such tears typically occur in the spine, dural tears can also occur in the posterior fossa. In many cases, posterior fossa dural tears are iatrogenic, and patients may present with neuroimaging evidence of postoperative pseudomeningoceles. We present a case of superficial siderosis caused by a persistent posterior fossa dural leak. The patient presented with superficial siderosis 30 years after a Chiari I malformation repair. A pinhole-sized dural tear was identified preoperatively using computed tomography cisternography. The dural defect was successfully repaired. An additional small tear that was not seen on imaging was also identified at surgery and successfully repaired.

Complex neuroimaging of traumatic brain injury: radiography and computed tomography

Every year, 1.5 million people die from traumatic brain injury, 50 thousand of them in Russia. A modern diagnostics of traumatic brain injury (TBI) reduces the mortality and improves the quality of medical care. The article discusses the advanced instrumental methods for diagnosing TBI: X-ray and CT of the skull, CT angiography, CT cisternography (CT-C), CT perfusion and selective cerebral angiography. The advantages and disadvantages of each method are considered. The authors also described the indications for each of the above-mentioned methods.

Traumatic Anterior Cranial Fossa CSF Leaks

Traumatic CSF leaks are reported to complicate 10–30% of skull base fractures. CSF rhinorrhea or otorrhea may be clinically apparent but in patients with less obvious leaks, β‎2-transferrin evaluation is the most sensitive and specific confirmatory test to establish the diagnosis of CSF leakage. High-resolution CT effectively identifies the majority of skull base fractures and sites of CSF leakage. Adjunctive imaging modalities such as CT cisternography and magnetic resonance cisternography may be used for further evaluation. Most traumatic CSF leaks of the anterior cranial fossa resolve spontaneously with conservative management including bedrest, head elevation, and avoidance of activities that increase intracranial pressure. The risk of meningitis increases significantly with persistent CSF leakage beyond 1 week, and intervention in the form of CSF diversion or surgical closure of the leak should be pursued. Prophylactic antibiotics have not been shown to decrease the risk of meningitis in patients with traumatic CSF leaks.

UTILIDAD DE LA CISTERNOGRAFÍA RADIOISOTÓPICA HÍBRIDA SPECT/CT 99MTC-O4--DTPA Y RMN EN EL DIAGNÓSTICO DE UN CASO DE HIPOTENSIÓN INTRACRANEAL ESPONTÁNEA: REVISIÓN DEL TEMA

Spontaneous intracranial hypotension (HIE) is an uncommon cause of secondary orthostatic headache, characterized by a decreased pressure and volume of cerebrospinal fluid (CSF), where dural quality and mechanical factors such as vertebral osteophytes play an important role, that after minimal trauma allow CSF leakage. We present the case of a 56-year-old male patient, who presented with severe postural headache, with a history of mild trauma at the level of the low thoracic spine with CSF pressure at the lower limit of normality, in whom radioisotopic SPECT/CT cisternography, provided the definitive diagnosis and exact anatomical location of the CSF leak, guiding treatment. A review of the pathophysiology, clinical presentation, diagnosis and treatment of HIE is carried out, emphasizing the diagnostic aid modalities, where hybrid imaging in nuclear medicine with SPECT/CT equipment allows a definitive diagnosis and management of HIE.