"A lot of highly specialized work has gone into perfecting our technique." "We performed our lateral decubitus DSM protocol and found a very large CSF-venous fistula," Dr. She cites a recent patient who came to Mayo Clinic after DSM at another major center didn't detect a CSF leak. Carr notes that DSM can yield varying results, depending on the techniques used.
Lateral decubitus DSM performed at Mayo Clinic shows a large complex CSF-venous fistula at the same location.ĭr. The patient subsequently experienced tinnitus, muffled hearing and constant daily headache. Image illustrates the diagnosis of a 61-year-old woman presenting with abrupt onset of Valsalva-related headache. A retrospective study published in Neurology in 2021 found that 53.2% of patients investigated for spontaneous intracranial hypotension at Mayo Clinic had a CSF leak identified on lateral decubitus DSM. Lateral decubitus DSM at Mayo Clinic has a high diagnostic yield for finding the exact location of a CSF leak. Lateral decubitus DSM is used when a CSF-venous fistula or nerve root sleeve tear is suspected. Hyperdynamic CT myelogram is used when a herniated disc or an osteophyte appears to have caused a rent in the dura and CSF leak. "Many patients are rendered bedbound, but effective treatment is often available once the leak is found." High diagnostic yieldĪt Mayo Clinic, specific findings on brain and spinal MRI guide decisions about subsequent myelography. Cutsforth-Gregory, M.D., a neurologist and director of the CSF dynamics clinic at Mayo Clinic in Minnesota. They are missing work and important life activities because of orthostatic headaches and other manifestations of CSF leaks," says Jeremy K. "Most patients I see are completely miserable. Spinal CSF leaks can cause debilitating symptoms. "A standard spine MRI, without these specialized techniques, often can't tell us what type of myelogram would best find the precise location of the leak." "Each of these successive steps is important," Dr. High-resolution spinal MRI, which can detect even very small areas of extradural fluid.High-resolution brain MRI, which can measure abnormalities down to the millimeter.Lateral decubitus DSM is part of Mayo Clinic's new imaging protocol for patients who present with spontaneous intracranial hypotension.
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