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Symptom Predictors of Cerebrospinal Fluid Leaks

Published online by Cambridge University Press:  02 December 2014

Kazuhiro Ohwaki ,
Eiji Yano ,
Teruyuki Ishii ,
Shigehiko Takanashi  and
Tadayoshi Nakagomi
Kazuhiro Ohwaki*
Affiliation:
Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
Eiji Yano
Affiliation:
Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
Teruyuki Ishii
Affiliation:
Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
Shigehiko Takanashi
Affiliation:
Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
Tadayoshi Nakagomi
Affiliation:
Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
*
Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo 173-8605, Japan.
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Abstract

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Background:

Spinal cerebrospinal fluid (CSF) leaks, which are considered a cause of intracranial hypotension, generally do not cause any local symptoms. Although symptoms are key elements for further evaluation, few studies have examined symptom predictors of intracranial hypotension. The aim of this study was to determine what symptoms are predictors of CSF leaks in patients suspected of intracranial hypotension.

Methods:

We performed radionuclide cisternography in 207 consecutive patients suspected of intracranial hypotension. Intracranial hypotension was suspected when a patient had a history of minor trauma and complained about uncontrolled headache, cranial nerve dysfunction, autonomic dysfunction, or higher brain dysfunction. The leakage of CSF was defined as direct signs of tracer leak into the spinal epidural space or early accumulation of the tracer in the urinary bladder. We obtained information on 16 symptoms commonly reported in previous studies.

Results:

CSF leaks were observed in 154 cases (74%). Back pain, limb pain, and limb numbness were inversely associated with CSF leaks (p = 0.042, p = 0.045, and p = 0.006, respectively). In logistic regression analysis, diplopia was a positive predictor of CSF leaks (odds ratio [OR], 6.53; 95% confidence interval [CI], 1.49 to 28.51), whereas limb numbness was a negative predictor (OR, 0.38; 95% CI, 0.17 to 0.84). Of the 21 patients in whom diplopia was present and limb numbness was absent, 20 had CSF leaks (specificity, 98%; positive predictive value, 95%).

Conclusion:

Some symptoms may be helpful in the diagnosis of CSF leaks in patients suspected of intracranial hypotension.

Résumé:

RÉSUMÉ: Contexte:

Les fuites spinales de liquide céphalorachidien (LCR), une cause d’hypotension intracrânienne, ne provoquent généralement pas de symptômes locaux. Bien que les symptômes soient l’élément le plus important motivant une évaluation plus poussée, peu d’études ont examiné les symptômes prédictifs de l’hypotension intracrânienne. Le but de cette étude était de déterminer quels symptômes prédisent les fuites de LCR chez les patients chez qui on soupçonne une hypotension intracrânienne.

Méthodes:

Nous avons effectué une cisternographie isotopique chez 207 patients consécutifs chez qui on soupçonnait la présence d’une hypotension intracrânienne. On soupçonnait une hypotension intracrânienne quand un patient avait des antécédents de trauma mineur et qu’il se plaignait de céphalée rebelle, de dysfonction de nerfs crâniens, de dysfonction neurovégétative ou de dysfonction cérébrale supérieure. Des signes directs de fuite du marqueur radioactive dans l’espace épidural spinal ou une accumulation précoce du marqueur dans la vessie étaient considérés comme révélateurs d’une fuite de LCR. Nous avons recueilli l’information concernant 16 symptômes communément associés à une fuite de LCR dans des études antérieures.

Résultats:

Des fuites de LCR ont été observées chez 154 patients (74%). Des douleurs au dos, aux membres et des engourdissements des membres étaient inversement associés à la présence de fuites de LCR (p = 0,042, p = 0,045 et p = 0,006 respectivement). L’analyse de régression logistique a montré que la diplopie était un symptôme prédictif positif des fuites de LCR (RC 6,53 ; IC à 95% : 1,49 à 28,51), alors que l’engourdissement au niveau des membres était un symptôme prédictif négatif (RC 0,38 ; IC à 95% : 0,17 à 0,84). Parmi les 21 patients qui présentaient une diplopie sans engourdissement au niveau des membres, 20 avaient une fuite de LCR (spécificité de 98% ; valeur prédictive positive de 95%).

Conclusion:

Certains symptômes peuvent être utiles dans le diagnostic d’une fuite de LCR chez les patients chez qui on soupçonne une hypotension intracrânienne.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 4 , September 2008 , pp. 452 - 457
Copyright
Copyright © The Canadian Journal of Neurological 2008

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