Radionuclide Cisternography in Spontaneous Intracranial Hypotension: A Case Report and Literature Review

Received 9/30/2003; revised 10/25/2003; accepted 11/1/2003. For correspondence or reprints contact: Chien-Chin Hsu, M.D., Department of Nuclear Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan. Tel: (886)7-3121101 ext. 7152, Fax: (886)7-3117521, E-mail: [email protected] Spontaneous intracranial hypotension (SIH), by definition, is spontaneous and without any obvious cause. The exact pathogenesis of SIH is stil l not clear. However, an occult cerebrospinal fluid (CSF) leak is considered as the cause of most if not all SIH. A 38year-old woman with postural headache and low CSF pressure was reported in this article. The Tc-diethyltriaminepentacetic acid (DTPA) radionuclide cisternography (RNC) was performed and showed accumulation of radiotracer in the extra-arachnoid space over upper portion of thoracic spine. Besides, the indirect signs of early appearance of urinary bladder radioactivity on the 30-min image and poor migration of radiotracer over the cerebral convexities on the 24-h image were also noted. RNC is able to detect and localize the site of CSF leak and is useful as an initial diagnostic study of choice in SIH.