Head-hanging CT: an alternative method for evaluating traumatic CSF rhinorrhea.

A number of methods have evolved to examine the patient with posttraumatic CSF rhinorrhea. Until the advent of metrizamide CT cisternography, radioisotope cisternography was the predominant method of investigation. Metrizamide cisternography has preempted the use of isotopes because of its more precise ability to localize the site of CSF leakage [1-5]. However, this method, which requires lumbar or cervical instillation of contrast medium (usually with fluoroscopic guidance) and careful tilting of the patient to guide the contrast into the head, can be cumbersome in severely traumatized patients. We have found a simpler method-CT in the headhanging position-using intracranial air already present from CSF leak, which demonstrates the site of dural tear in some patients. This technique may be used as an adjunct to, or replacement for, metrizamide cisternography (Fig. 1). Such a method has not been emphasized in the CT literature.