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Images in Neurology |

Spontaneous Cerebrospinal Fluid Leak With Venous Engorgement Mimicking a Contrast-Enhancing Cervical Mass

Marina Herwerth, MD1,2; Sascha Prothmann, MD3; Kornelia Kreiser, MD3; Bernhard Hemmer, MD1,2; Markus Ploner, MD2
[+] Author Affiliations
1Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
2Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
3Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
JAMA Neurol. 2016;73(7):886-887. doi:10.1001/jamaneurol.2016.0277.
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This case report describes a woman in her early 40s with fluctuating neck pain in whom imaging revealed spontaneous cerebrospinal fluid leakage with engorgement of venous plexus.

A woman in her early 40s presented to the emergency department with a 2-month history of fluctuating neck pain. Neurologic examination findings were unremarkable. Cerebral magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination results were normal. Spinal MRI revealed a contrast-enhancing cervical epidural mass (Figure, C). An inflammatory or neoplastic process was suspected and a biopsy was considered.

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Figure.
Imaging Findings of Cerebrospinal Fluid Leakage

A-C, Axial magnetic resonance imaging (MRI) sequences showed an initially prominent epidural cervical mass (arrowheads) (A, T2-weighted multiple-echo data image combination) that disappeared in the follow-up MRI (B, T2-weighted multiple-echo data image combination) and recurred (arrowheads) with the onset of new symptoms (C, gadolinium-enhanced, T1-weighted spectral presaturation with inversion recovery). D, Sagittal gadolinium-enhanced, T1-weighted spectral presaturation with inversion recovery MRI showed recurrence (arrowheads). E, Sagittal computed tomography (CT) angiography identified the cervical structure as engorged venous plexus (arrowheads). F, Sagittal CT myelography showed contrast leaks (arrowheads) into the ventral and dorsal epidural compartment. G, Postinterventional MRI demonstrated regression of previously enlarged venous plexus (arrowheads) (compare with D). Venous structures are shown in A-E and G, whereas epidural cerebrospinal fluid accumulation is shown in F.

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