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Abstract Details

Rapidly Cognitive Decline Secondary to CSF Venous Fistula with Post-Operative Rebound Intracranial Hypertension and a Hyperintense Paraspinal Vein Sign Seen Retrospectively
General Neurology
P2 - Poster Session 2 (8:00 AM-9:00 AM)
6-009

Review a case study and literature review on spontaneous cerebrospinal fluid venous fistula with a new imaging finding seen retrospectively.

A 56 year old female with two prior chiari decompressions presented with rapidly progressive cognitive decline. MRI Brain revealed a venous distension, low lying cerebellar tonsils, ventricular compression, dural enhancement. T2 weighted MRI with STIR sequencing and CT Myelogram revealed left T-9 perineural cysts. Prone digital subtraction myelography (DSM) did not reveal CSF leaks. Symptoms improved after multi-level blood patches. Four months later cognitive decline recurred and repeat left lateral decubitus DSM revealed a CSF venous fistula (SCVF) at T9. Neurosurgeons ligated the left T9 nerve root and repeat imaging showed resolution of SCVF. The patient experienced “high pressure” headaches on postoperative day 9. Papilledema was suspected on fundoscopic exam and confirmed on Ocular Coherence Tomography (OCT). The patient was placed on Acetazolamide with resolution of headaches two months later.  A hyperintense paraspinal vein was seen retrospectively on T2 weighted MRI with Dixon Fat Suppression Sequencing.
This case was compared to PubMed search results for SCVF imaging standards, cognitive decine due to SCVF, and rebound intracranial hypertension treatment.

A hyperintense paraspinal vein seen on T2 weighted MRI with Dixon Fat Suppression sequencing has not been previously described.

A SCVF became clear in left lateral decubitus DSM after being absent on prone DSM; consistent with current imaging standards.

Rebound intracranial hypertension resolved with Acetazolamide, no trials of prophylactic diamox have been documented.

No prior cases of rapid cognitive decline due to SCVF have been reported.

This case is unique in the acuity of cognitive decline secondary to CSF leak.

Acetazolamide at the time of blood patch may potentially be used as prophylaxis for rebound intracranial hypertension.

The hyperintense paraspinal vein may have utility in future diagnosis of SCVF.
Authors/Disclosures
Peter S. Tatum, DO (TUFTS)
PRESENTER 		No disclosure on file
Emily Anderson (VA Hospital) No disclosure on file
No disclosure on file
Osamah Alnasser, MD (Carilion Clinic) Dr. Alnasser has nothing to disclose.
No disclosure on file
Deborah M. Green-LaRoche, MD The institution of Dr. Green-LaRoche has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Boston Clinical Trials. Dr. Green-LaRoche has received publishing royalties from a publication relating to health care.
Neel Madan No disclosure on file