Floating dural sac sign is a sensitive magnetic resonance imaging finding of spinal cerebrospinal fluid leakage.
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We would like to propose floating dural sac sign, which is observed as a hyperintense band or rim around the spinal dural sac on axial T2-weighted images, as a sensitive sign to identify cerebrospinal fluid (CSF) leakage. One hundred patients with orthostatic headache were prospectively registered in 11 hospitals. These patients were examined by brain magnetic resonance (MR) imaging (n = 89), radioisotope cisternography (n = 89), MR myelography (n = 86), axial T2-weighted imaging of the spine (n = 70), and computed tomography myelography (n = 2). In this study, we separately evaluated the imaging findings of intracranial hypotension and spinal CSF leakage. Among 100 patients, 16 patients were diagnosed as having spinal CSF leaks. Of 70 patients examined with axial T2-weighted imaging, 14 patients were diagnosed with spinal CSF leaks, and floating dural sac sign was observed in 17 patients, 13 patients with spinal CSF leaks and 4 without CSF leaks (sensitivity 92.9%, specificity 92.9%). Of 86 patients examined by MR myelography, extradural fluid was observed in only 3 patients (sensitivity 21.4%, specificity 100%). The floating dural sac sign was a sensitive sign that can be used to identify CSF leakage. Spinal axial T2-weighted imaging might be a good screening method for spinal CSF leakage that can help to avoid the need for lumbar puncture. (+info)
The role of traumatic subdural fluid collections in the development of chronic subdural haematomas was studied in 43 of 715 patients who underwent a CT scan because of a recent head injury. Twenty of the 43 patients subsequently developed a chronic subdural haematoma, and this occurred especially in the aged. Nearly 50% of patients with asymptomatic or minimally symptomatic subdural fluid collection may develop a chronic subdural haematoma. (+info)
Methods of measuring intracranial pressure via the fontanelle without puncture.
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It is suggested that non-invasive techniques for measuring intracranial pressure should be suitable for use in the unsedated infant and should be capable of measuring pressure continuously. Methods described by other authors are reviewed. After investigation of 18 patients the technique relying upon the pulsation of the fontanelle described by Purin was rejected as being difficult to perform and applicable only in certain patients with large fontanelles. The technique of using a modified Schiotz tonometer was examined but rejected on grounds of inaccuracy, the need to perform the measurement with the infant in a vertical position, and the varying compressibility of the fontanelle. A method for indirectly estimating intracranial pressure using a modified aplanation principle is described, and a comparison of the pressures so measured and needle pressures is reported. The possible uses of a `fontanometer' using the aplanation principle are discussed and a preliminary report given of its use to monitor the changes of intracranial pressure caused by drugs. (+info)
Detection of extracerebral fluid collections by real-time sector scanning through the anterior fontanelle.
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Real-time sector sonography through the anterior fontanelle has proved useful in detecting extracerebral fluid collections when a water bath is utilized. With this technique, six patients had their extracerebral fluid collections visualized. The role of this procedure in following the course of these patients is discussed. (+info)
Echographic demonstration of extracerebral fluid collections with the lateral technique.
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The authors describe the technique of real-time sector scanning in the coronal plane through the side of the head to visualize the opposite cerebral convexity. This lateral technique utilizes the temporal squama and/or coronal suture as windows, and often requires the use of a 3.0-MHz transducer. Several cases illustrate extracerebral fluid or echogenic blood collections in which the lateral technique added useful information not shown by standard imaging through the anterior fontanelle. Four of the fluid collections were not visible with standard imaging techniques. The lateral technique appears to be a useful addition to the cranial echogram. (+info)
Chronic subdural hematoma may be preceded by persistent traumatic subdural effusion.
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The incidence of traumatic subdural effusion (TSE) was analyzed to clarify the relationship with subsequent chronic subdural hematoma (CSH) in 500 patients with head injury evaluated over a 36-month period. TSE occurred in 108 patients (21.6%), and CSH developed in 29 (5.8%) of these. The incidence of TSE was high, although only hospitalized patients were included because of the necessity for serial computed tomography. TSE frequently developed into CSH, and all CSH followed TSE. Therefore, TSE is closely associated with CSH and subdural effusion is probably a preliminary stage necessary for the formation of CSH. (+info)