Cerebrospinal fluid leaks from penetrating injuries: Diagnosis and treatment

John C. Styliaras, R. Dalyai, H. Amgad, A. Sharan, J. Harrop

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Penetrating Spinal Cord Injuries are often complicated by Cerebrospinal Fluid (CSF) leaks, which can be diagnosed either at initial presentation, or present themselves in a delayed fashion. Symptoms are usually non-specific and include positional headaches, nausea, vomiting, vertigo, and may even include hypotension, cranial nerve palsies, and in severe cases, meningitis. Imaging to detect CSF leaks include: plain radiographs, CT and MRI, CT-myelogram, radionuclide cisternograms, MRI with intrathecal gadolinium. Initial treatment of CSF leaks is conservative, including bedrest, hydration/overhydration, and medications such as caffeine and theophylline. Although overall treatment protocols are controversial, there seems to be a consensus that if a CSF leak persists for over 96 hours, it should be surgically treated, as it would inevitably increase the risks of pseudomeningocele formation and meningitis. Surgical options include a blood/fibrin patch, the placement of a lumbar drain, and ultimately surgical exploration and primary closure of the dural defect.

Original languageEnglish (US)
Pages (from-to)183-187
Number of pages5
JournalArgoSpine News and Journal
Volume24
Issue number3-4
DOIs
StatePublished - Dec 1 2012

Keywords

  • CT-myelogram
  • cerebrospinal leak
  • diagnosis of CSF leak
  • dural defects
  • intrathecal gadolinium
  • penetrating injury
  • radionuclide cisternogram
  • traumatic spinal cord injury
  • treatment of CSF leak

ASJC Scopus subject areas

  • Surgery
  • Anatomy
  • Orthopedics and Sports Medicine
  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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