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Intracranial hypotension secondary dislocation of the cervical spine
The Spine Journal 14 (2014) 1074
Intracranial hypotension secondary dislocation of the cervical spine A 9-year-old boy presented with a 3-day history of severe headache and neck pain. One week before presentation, he had fallen from standing height but did not report subsequent paresthesia. On physical examination, there was a reduced range of movement of the cervical spine. Sagittal T2-weighted craniocervical magnetic resonance imaging revealed a spinal cord angulation with mild compression and minimal intramedullary edema (Fig. 1). There were a reversal of the cervical lordosis and anterior displacement of 20% of C2 on C3. Sagittal image also showed the cerebellar tonsils at the foramen magnum and obliteration of the prepontine and suprasellar cisterns. Axial T1-weighted cerebral imaging revealed the diffuse dural thickening and slit ventricle appearance (Fig. 2).
Fig. 2. Axial T1-weighted cerebral MRI shows the diffuse dural thickening (short arrows) and slit ventricle appearance (long arrows). MRI, magnetic resonance imaging.
From these images, it was concluded that there was a traumatic dural cerebrospinal fluid leak causing intracranial hypotension. A closed reduction was performed. After reduction, the patient had improved with conservative management. Hayri Ogul, MD Mecit Kantarci, MD, PhD Department of Radiology Faculty of Medicine Ataturk University 200 Evler Mah. 14. Sok No 5 Dadaskent Erzurum 25240, Turkey FDA device/drug status: Not applicable. Author disclosures: HO: Nothing to disclose. MK: Nothing to disclose. Fig. 1. Sagittal T2-weighted craniocervical MRI shows a spinal cord angulation with mild compression and minimal intramedullary edema. It shows the cerebellar tonsils at the foramen magnum (short arrow) and obliteration of the basal and supracerebellar cisterns. Sagittal image also reveals an anterior displacement (long arrow) of 20% of C2 on C3 and CSF leak (asterisk) in retropharyngeal space. MRI, magnetic resonance imaging; CSF, cerebrospinal fluid. 1529-9430/$ - see front matter Crown Copyright Ó 2014 Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.01.023
Intracranial hypotension secondary dislocation of the cervical spine A 9-year-old boy presented with a 3-day history of severe headache and neck pain. One week before presentation, he had fallen from standing height but did not report subsequent paresthesia. On physical examination, there was a reduced range of movement of the cervical spine. Sagittal T2-weighted craniocervical magnetic resonance imaging revealed a spinal cord angulation with mild compression and minimal intramedullary edema (Fig. 1). There were a reversal of the cervical lordosis and anterior displacement of 20% of C2 on C3. Sagittal image also showed the cerebellar tonsils at the foramen magnum and obliteration of the prepontine and suprasellar cisterns. Axial T1-weighted cerebral imaging revealed the diffuse dural thickening and slit ventricle appearance (Fig. 2).
Fig. 2. Axial T1-weighted cerebral MRI shows the diffuse dural thickening (short arrows) and slit ventricle appearance (long arrows). MRI, magnetic resonance imaging.
From these images, it was concluded that there was a traumatic dural cerebrospinal fluid leak causing intracranial hypotension. A closed reduction was performed. After reduction, the patient had improved with conservative management. Hayri Ogul, MD Mecit Kantarci, MD, PhD Department of Radiology Faculty of Medicine Ataturk University 200 Evler Mah. 14. Sok No 5 Dadaskent Erzurum 25240, Turkey FDA device/drug status: Not applicable. Author disclosures: HO: Nothing to disclose. MK: Nothing to disclose. Fig. 1. Sagittal T2-weighted craniocervical MRI shows a spinal cord angulation with mild compression and minimal intramedullary edema. It shows the cerebellar tonsils at the foramen magnum (short arrow) and obliteration of the basal and supracerebellar cisterns. Sagittal image also reveals an anterior displacement (long arrow) of 20% of C2 on C3 and CSF leak (asterisk) in retropharyngeal space. MRI, magnetic resonance imaging; CSF, cerebrospinal fluid. 1529-9430/$ - see front matter Crown Copyright Ó 2014 Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.01.023