Imaging of Suspected Intracranial Hypotension MRI Complete Spine Without IV Contrast MRI complete spine without IV contrast optimized with fluid sensitive sequences is most useful as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension, particularly when performed with 3-D T2-weighted fat saturated sequences, which increases sensitivity for detecting fluid collections outside of the thecal sac [52]. This examination can detect with a high degree of accuracy the presence of epidural fluid collections and meningeal diverticula that can inform positioning and regions of interest for subsequent CSF leak localization imaging examinations, such as dynamic CT myelogram complete spine and digital subtraction myelography complete spine [25,34-36]. Radiographic Myelography Digital Subtraction Complete Spine There is no relevant literature to support the use of dynamic digital subtraction myelogram complete spine as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. Dynamic digital subtraction myelography plays an important role in the subsequent imaging workup of SIH after initial brain and spine imaging [53]. Results from an initial spine MRI or conventional CT myelogram provide useful information on how a subsequent dynamic digital subtraction myelogram will be performed, such as prone positioning for suspected ventral dural defect or decubitus positioning for suspected leaking meningeal diverticulum or CSF-venous fistula [24,53,54]. Dynamic digital subtraction myelography involves continuous real- time fluoroscopic x-ray imaging of the entire spine or of a focused region of the spine where there is suspicion for CSF leak.
Imaging of Suspected Intracranial Hypotension PCAs. Imaging of Suspected Intracranial Hypotension MRI Complete Spine Without IV Contrast MRI complete spine without IV contrast optimized with fluid sensitive sequences is most useful as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension, particularly when performed with 3-D T2-weighted fat saturated sequences, which increases sensitivity for detecting fluid collections outside of the thecal sac [52]. This examination can detect with a high degree of accuracy the presence of epidural fluid collections and meningeal diverticula that can inform positioning and regions of interest for subsequent CSF leak localization imaging examinations, such as dynamic CT myelogram complete spine and digital subtraction myelography complete spine [25,34-36]. Radiographic Myelography Digital Subtraction Complete Spine There is no relevant literature to support the use of dynamic digital subtraction myelogram complete spine as a next imaging study in the clinical setting of obtundation with initial brain imaging features of suspected intracranial hypotension. Dynamic digital subtraction myelography plays an important role in the subsequent imaging workup of SIH after initial brain and spine imaging [53]. Results from an initial spine MRI or conventional CT myelogram provide useful information on how a subsequent dynamic digital subtraction myelogram will be performed, such as prone positioning for suspected ventral dural defect or decubitus positioning for suspected leaking meningeal diverticulum or CSF-venous fistula [24,53,54]. Dynamic digital subtraction myelography involves continuous real- time fluoroscopic x-ray imaging of the entire spine or of a focused region of the spine where there is suspicion for CSF leak.