Diagnostic approach, therapeutic strategies, and surgical indications in intradural thoracic disc herniation associated with CSF leak, intracranial hypotension, and CNS superficial siderosis
| العنوان: | Diagnostic approach, therapeutic strategies, and surgical indications in intradural thoracic disc herniation associated with CSF leak, intracranial hypotension, and CNS superficial siderosis |
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| المؤلفون: | Giulio Bonomo, Alberto Cusin, Emanuele Rubiu, Guglielmo Iess, Roberta Bonomo, Giorgio Battista Boncoraglio, Mario Stanziano, Paolo Ferroli |
| المساهمون: | Bonomo, G, Cusin, A, Rubiu, E, Iess, G, Bonomo, R, Boncoraglio, G, Stanziano, M, Ferroli, P |
| المصدر: | Neurological Sciences. 43:4167-4173 |
| بيانات النشر: | Springer Science and Business Media LLC, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | CNS superficial siderosi, Siderosis, Cerebrospinal Fluid Leak, Settore MED/27 - Neurochirurgia, Intracranial Hypotension, CNS superficial siderosis, CSF leak, Intracranial hypotension, Intradural thoracic disc herniation, Dermatology, General Medicine, Magnetic Resonance Imaging, Thoracic Vertebrae, Psychiatry and Mental health, Humans, Female, Neurology (clinical), Intervertebral Disc Displacement, Aged |
| الوصف: | Background and purpose Intradural disc herniation (IDH) can manifest with radicular or medullary syndrome. In about 15% of cases, IDH may be responsible, through a dural laceration, for a CSF leak, determining spontaneous intracranial hypotension (SIH) and CNS superficial siderosis (CNSss). This paper attempts to present an overview on IDH as the cause for both CSF leak, and subsequent SIH, and CNSss, and to describe a peculiar clinical and neuroradiological scenario related to this condition. Methods A search on the PUBMED database was performed. Although the investigation did not rigorously follow the criteria for a systematic review (we consider only articles about thoracic IDH), nonetheless, the best quality evidence was pursued. Furthermore, an illustrative case was presented. Results A 69-year-old woman was referred to our hospital for slowly progressive gait disturbances and hearing impairment. Brain imaging revealed diffuse bilateral supratentorial and infratentorial superficial siderosis, mostly of the cerebellum, the eighth cranial nerves, and the brainstem. Spinal imaging disclosed a posterior disc herniation determining a dural tear at D6-D7. Lumbar puncture revealed low opening pressure and hemorrhagic CSF with siderophages. A posterior transdural herniectomy and dural sealing determined a stabilization of hearing and a significant improvement in both gait and balance. Conclusions The diagnostic workup of CNSss with suspected CNS leak demands whole neuraxis imaging, especially in cases presenting SIH or myelopathic symptoms. This may avoid delays in detection of IDH and spinal dural leaks. The different forms of treatment available depend on the type and severity of the clinical picture. |
| وصف الملف: | STAMPA |
| تدمد: | 1590-3478 1590-1874 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2dfff07d399d3ced97b23ab4cf2c1b86Test https://doi.org/10.1007/s10072-022-06059-yTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....2dfff07d399d3ced97b23ab4cf2c1b86 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15903478 15901874 |
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