Affiliations: Department of Diagnostic and Interventional Imaging,
School of Medicine at Houston, University of Texas, Houston, TX, USA | Division of Pediatric Neurology, School of Medicine at
Houston, University of Texas, Houston, TX, USA | Emory University Hospital Midtown, Atlanta, GA, USA
Note: [] Correspondence: Dr. David Q. Wan, M.D., Department of
Diagnostic and Interventional Imaging, School of Medicine at Houston,
University of Texas, 6431 Fannin Street, MSB 2.130B, Houston, TX, USA. Tel.: +1
713 704 1776; Fax: +1 713 704 1596; E-mail: david.q.wan@uth.tmc.edu
Abstract: We present a 14-year-old female patient with a 2 yr history of
positional headache secondary to spontaneous diffuse cerebrospinal fluid (CSF)
leaks. We treated the leak with an epidural blood patch which was radioactively
labeled by a well-established nuclear medicine technique. Because spontaneous
CSF leaks were frequently multifocal or diffuse throughout the spine, the
extent of coverage or distribution of an epidural patch was generally
determined by best estimate. Traditional radiographic contrast media mixed with
the blood cells had been used to monitor the patch coverage and it is
questionable whether the contrast can be representative of the cell
distribution. We applied a nuclear medicine technique to label the autologous
red blood cells to monitor the range of spinal cord coverage of each epidural
patch. After two visible epidural patches covered both the lumbar and thoracic
spine, computed tomography myelogram demonstrated significantly decreased
leakage when compared to the pre-patch images. However, the patient's symptoms
remained essentially unchanged in the long term, which is consistent with
refractory spontaneous CSF leaks. We believe that this sophisticated nuclear
medicine blood labeling technique is a simple and accurate way to monitor the
true cell coverage of the spine and the pattern of distribution.
