![]() ![]() ![]() A hand-held dynamometer revealed his weakened grip strength of both of his hands by 30–40 kg. The patient admitted to our department soon after the initial contact. Here, we report suggestive strategies of diagnosis and treatment of intracranial hypotension. Moreover, we performed combined therapies which include burr-hole drainage of the subdural hematoma, blood-patch therapy and laminoplasty. We have recently encountered a patient with intracranial hypotension in association with spinal canal stenosis as its potential etiological factor, and were presented with a characteristic imaging with the C1-C2 sign. In other words, the site of dural tear which makes the connection between intra- and epidural spaces is possibly different from the site of tear on the posterior atlantoaxial membrane at C1-C2 level which makes fluid collection in the retrospinal tissue. This discrepancy comes from dynamics of the leaked CSF in the spinal canal. the site of dural tear) in other patients. the site of dural tear) in some patients, but not necessarily indicates the site of CSF leakage (i.e. An interesting and important consideration of this sign is that the retrospinal point at C1-C2 level exactly indicates the site of CSF leakage (i.e. Further, to the best of our knowledge, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension.Ĭ1-C2 sign is a characteristic imaging feature, which indicates CSF collection in retrospinal soft tissue between the spinous processes of C1 and C2 levels, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. Intracranial hypotension is typically caused by loss of CSF through nerve root sleeve diverticulum, dural defect due to osteophyte spur or CSF-venous fistula in the thoracic or lumbar spine however, underlying pathophysiology remains incompletely understood. Intracranial hypotension has gained increasing recognition over the past 20 years, as a disorder of low cerebrospinal fluid (CSF) pressure characterized by postural headache, brain sagging and chronic subdural hematomas. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3–4 at the same time. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. Case presentationĪ 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. ![]() Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension.Ĭ1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. ![]()
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