Presentation
Spontaneous intracranial hypotension, failed blood patch x4, negative CT myelography.
Patient Data
No evidence of contrast leak/extravasation, particularly at the T8 level. Several scattered tiny nerve root sheath cysts/diverticula noted.
MR thoracic myelogram (with intrathecal gadolinium) has been performed with T1 fat suppressed sequences through the thoracic spine at 1 hours and again at 4.5 hours post injection. There is still no evidence of contrast leak/extravasation.
Case Discussion
Identifying slow CSF leaks can be challenging at it is not uncommon for this to require multiple examinations. Blood patch performed speculatively is a very reasonable approach and often results in successful treatment.