A1 and B1 reprinted that have permission regarding Kumar N
A good and you will B, Axial (A) and you will coronal postcontrast (B) T1-weighted MR photo out-of the patient with SS reveal diffuse pachymeningeal is alua free enhancement similar to you to definitely said from inside the patients that have craniospinal hypotension. (exact same patient due to the fact found when you look at the 11A1 and you may A2). C, Axial CT test away from a patient having SS reveals enhanced attenuation around the pons because of thought calcification of your own hemosiderin deposition. Superficial siderosis and you can CSF hypovolemia: the latest problem (dural) regarding connect. Neurology 2007;–26 (Copyright laws 2007, Wolters Kluwer Health).
B1 and B2, Associated sagittal (reformatted) (B1) and you can axial (B2) postmyelography CT photographs show opacification of ventral epidural fluid by the intrathecal evaluate for the exact same training given that CSF, hence guaranteeing an active leak
A secondary idea for the etiology from SS are evident on the MR imaging. A fluid-filled intraspinal cavity from varying dimensions is sometimes seen (Fig 4A, -C1 and you can C2, D?G; Fig 6A1 and A2, B1 and B2; Fig 7A1 and you may A2; in addition to seen towards the CT myelogram in the Fig 7B1 and you will B2 and you may Fig 10A). dos,3,28 –29,thirty-five,36 Hardly the fresh new fluid-occupied hole may be intracranial (Fig 4B). 43 This type of localized liquid-filled cavities was variably known as meningoceles, pseudomeningoceles, diverticula, pseudoencephalocele, epidural cyst, or simply since the “water choices.†Bravery resources avulsions, tend to in association with brachial plexus burns off and you may pseudomeningoceles, is actually a typically reported relationship. 2,ten,eleven,fourteen,17,twenty-seven,forty-two A disturbance about circumferential hypointensity on the axial T2-adjusted MR imaging may indicate means avulsion and that’s perhaps due to lack of the fresh pia mater during the avulsion web site (Fig 8A; also viewed into a great CT myelogram in the Fig 10C). twenty seven Proof bony injury (Fig 8C; together with seen for the CT test when you look at the Fig 10B), myelomalacia (Fig 8D), otherwise cable tethering (Fig 4F) could be introduce. Others recognized sourced elements of bleeding inside patients having SS features typically provided neoplasms and you can vascular malformations. Mind amyloid angiopathy may also be for the proof hemosiderin deposition the same as one to found in SS (Fig 8E). forty five
Good and B, Pre- (A1 and you may A2) and postoperative (B1 and you can B2) sagittal (A1 and B1) and you may axial (A2 and you will B2) T2-adjusted MR photo out-of a patient which have SS reveal a serious reduced amount of a beneficial longitudinally extensive liquid-filled collection prior on spinal-cord just after repair out of a good dural problem in the T11. This site of the dural problem is localized because of the an energetic CT myelogram. Superficial siderosis: connectivity and you may therapeutic effects. Arc Neurol 2007;–96 (Copyright 2007, American Medical Connection).
A1 and A2, Sagittal (A1) and you can axial (A2) T2-adjusted MR photos off someone that have SS tell you an effective cervicothoracic epidural water-occupied collection (white arrows) and you may a T5–six drive extrusion (black colored arrowhead) one to displaces the fresh new dura (white arrowhead) posteriorly. Note limited calcification of one’s disk (black arrowhead) while the exposure of an effective subarachnoid clot (black colored arrow). C, Horizontal look at the brand new thoracic spine obtained during the digital substraction myelography towards the patient in the vulnerable condition. Note cephalad extension of your examine from the thecal sac (black colored arrowhead), focal extravasation of one’s contrast due to a good ventral dural rip at T5–6 (white arrow) on epidural collection (black colored arrow), and you will forth cephalad expansion regarding epidural liquid range. This new asterisk suggests increased attenuation of your own contrast by reduced quantity of the new epidural space in contrast to the brand new subarachnoid room. In this diligent, a ventral dural rip during the T5–six was operatively repaired, and you will an excellent thoracic spine MR imaging did ninety days later displayed solution of your own ventral epidural water range. thirty-six Modified that have permission out of J.Yards. Hoxworth. 36
