Spontaneous leakage of cerebrospinal fluid causing orthostatic headache. Diagnosis and treatment based on radionuclide cisternography

We investigated overall results of epidural blood patch (EBP) treatment for patients who had the spontaneous leakage of cerebrospinal fluid (CSF). Findings of radionuclide cisternography in those patients were presented. One hundred and thirty-one patients were diagnosed to have possible CSF leakage from spinal dura according to the symptoms and MRI findings. They were subjected to radionuclide cisternography using 37 MBq 111In-diethylene triamine pentaacetic acid (DTPA). If patients had CSF leakage from spinal dura, EBP was done to seal the leakage site. The effect of treatment was evaluated subjectively and objectively from the medical record. Ninety-five patients (72.5%) showed definite CSF leakage. Ninety-one patients among 95 patients were received EBP treatment. EBP treatment was repeated up to 3 times if needed. Total 215 procedures were done in 91 patients, among which 80 cases were evaluated for the effect of epidural blood patch treatment. Among those, 23.5% of the patients were evaluated as ''cure'', and 62.5% of the patients showed partial improvement and rated as ''improving''. Another 13.8% were rated as ''unchanged''. Radionuclide cisternography using 111In-DTPA is useful for diagnosis of the spontaneous CSF leakage. EBP treatment is effective in the majority of the patients with spontaneous CSF leakage. (author)