Details

Autor(en) / Beteiligte

• Friedauer, Lucie
• Rezny‐Kasprzak, Beata
• Steinmetz, Helmuth
• du Mesnil de Rochemont, Richard
• Foerch, Christian

Titel

Spinal dural leaks in patients with infratentorial superficial siderosis of the central nervous system—Refinement of a diagnostic algorithm

Ist Teil von

• European journal of neurology, 2022-04, Vol.29 (4), p.1136-1144

Ort / Verlag

England: John Wiley & Sons, Inc

Erscheinungsjahr

2022

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Background and purpose Superficial siderosis of the central nervous system is a sporadic finding in magnetic resonance imaging, resulting from recurrent bleedings into the subarachnoid space. This study aimed to determine the frequency of spinal dural cerebrospinal fluid (CSF) leaks amongst patients with a symmetric infratentorial siderosis pattern. Methods In all, 97,733 magnetic resonance images performed between 2007 and 2018 in our neurocenter were screened by a keyword search for “hemosiderosis” and “superficial siderosis.” Siderosis patterns on brain imaging were classified according to a previously published algorithm. Potential causative intracranial bleeding events were also assessed. Patients with a symmetric infratentorial siderosis pattern but without causative intracranial bleeding events in history were prospectively evaluated for spinal pathologies. Results Forty‐two patients with isolated supratentorial siderosis, 30 with symmetric infratentorial siderosis and 21 with limited (non‐symmetric) infratentorial siderosis were identified. Amyloid angiopathy and subarachnoid hemorrhage were causes for isolated supratentorial siderosis. In all four patients with a symmetric infratentorial siderosis pattern but without a causative intracranial bleeding event in history, spinal dural abnormalities were detected. Dural leaks were searched for in patients with symmetric infratentorial siderosis and a history of intracranial bleeding event without known bleeding etiology, considering that spinal dural CSF leaks themselves may also cause intracranial hemorrhage, for example by inducing venous thrombosis due to low CSF pressure. Thereby, one additional spinal dural leak was detected. Conclusions Persisting spinal dural CSF leaks can frequently be identified in patients with a symmetric infratentorial siderosis pattern. Diagnostic workup in these cases should include magnetic resonance imaging of the whole spine. Screening was carried out on 97,733 magnetic resonance images performed in our neurocenter for superficial siderosis. Patients with a symmetric infratentorial siderosis pattern in brain magnetic resonance imaging were prospectively evaluated for spinal dural cerebrospinal fluid leaks. Our results show that persisting spinal dural cerebrospinal fluid leaks can frequently be identified in patients with a symmetric infratentorial siderosis pattern, and therefore diagnostic workup in these cases should include magnetic resonance imaging of the whole spine.