Teaching NeuroImages: False-positive magnetic resonance sign in spontaneous spinal CSF leak.

X.-L. Tan, MD, PhD Q.-D. Yang, MD, MSc X.-J. Liu, MD B. Xiao, MD, PhD B.-S. Tang, MD A 39-year-old woman developed orthostatic headache. Cranial MRI indicated spontaneous intracranial hypotension (SIH) (figure, A). Spinal MRI suggested CSF leaks at C1–2, C2–3, and C5–6 levels (figure, B and C), but both radionuclide cisternography and CT myelography (immediate and 3-hour delayed scanning) showed no CSF leak at C1–2 and C2–3 levels (figure, D–F). Conservative management with absolute bed rest and IV hydration resulted in gradual disappearance of the headache in 3 weeks and MRI resolution in 3 months. Extra-arachnoid fluid collections at C1–2 and C2–3 levels are common MRI findings of SIH.1,2 However, MRI is a static rather than dynamic study. These collections do not necessarily indicate the actual CSF leakage sites and are probably the result of a transudate from local dilated epidural veins.2