Incidental findings of CSF leakage in patients without spontaneous intracranial hypotension and development of post-dural puncture headache.

OBJECTIVES

To determine if nerve root sleeve diverticula or CSF leakage correlate with post-dural puncture headache (PDPH).

METHODS

A total of 781 lumbar and 408 cervical post-myelogram CTs were reviewed using a total diverticulum and leakage (TDL) score: 1, nerve root sleeve diverticulum not beyond the lateral vertebral body; 2, diverticulum beyond the lateral vertebral body; 3, periradicular contrast; 4, epidural contrast medium collection. Two scores at each level (left, right) were added for a total score. Results were correlated with post-procedure follow-up.

RESULTS

PDPH occurred in 22 (2.8 %) lumbar and 15 (3.7 %) cervical patients. Iodine concentration was not significantly different in lumbar (P = 0.14) or cervical (P = 0.85) patients with or without PDPH. Total scores correlated with PDPH after lumbar (P < 0.0001) and cervical (P < 0.0001) myelography. PDPH patients were younger (P = 0.002 lumbar, P = 0.0001 cervical) and more were female (P = 0.039 lumbar, P = 0.045 cervical). Using multiple regression, a lumbar epidural contrast collection or cervical diverticulum extending beyond the lateral vertebral body correlated with PDPH (P < 0.0001 and P = 0.03, respectively).

CONCLUSIONS

PDPH correlates with a higher TDL score. Lumbar epidural contrast medium collections and cervical diverticula extending beyond the lateral vertebral body margin are associated with PDPH.

KEY POINTS: • Elongated cervical nerve root sleeve diverticula are associated with post-dural puncture headaches. • Lumbar epidural contrast medium collections are associated with post-dural puncture headaches. • This information may help assess the risk of post-dural puncture headache.