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2015, Number 2

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Anales de Radiología México 2015; 14 (2)

Usefulness of CT cisternography in evaluation of cerebrospinal fluid fistulas

Osorio-Valero M, Carrillo-Novia D, Grande-Miranda H

Language: Spanish
References: 43
Page: 215-227
PDF size: 564.05 Kb.


ABSTRACT

We present the case of a patient of 56 years of age with diagnosis of cerebrospinal fluid fistula, referred from a regional hospital for evaluation and treatment. Relevant antecedents include: two months before admission he suffered craniocerebral trauma in the occipital region resulting from a fall from his own height. He immediately presented constant, hyaline anterior rhinorrhea with a salty taste associated with mild intermittent dysphagia and high pitched tinnitus. Flexible fiber optic laryngoscopy, with the Valsalva maneuver, showed leakage of hyaline fluid from both nasal sinuses, originating in the region of the right nasal attic, at the insertion site of the middle turbinate. A cytochemical analysis of the nasal fluid obtained was conducted and it was identified as cerebrospinal fluid. Then water soluble contrast medium was administered by lumbar puncture to perform cisternography and a tomography with multiple detectors (also known as multislice tomography) was taken, with special attention to the frontonasal region. Multiplane reconstruction and 3D images were obtained.
Cisternography with multislice tomography is considered by some authors the procedure of choice for diagnosis and evaluation of cerebrospinal fluid fistulas; it is very helpful in identifying the site of the defect and determining its extension. It has limitations in inactive or low flow cerebrospinal fluid fistulas.


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