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<b>MILITARY CENTRAL HOSPITAL 108</b>

<b>A CASE WITH CEREBROSPINAL FLUID LEAK </b>

<b>DIAGNOSED BY MYELOGRAPHY TECHNIQUE</b>

<b>Nguyen Duy Hai, Pham Minh Chi, Do Duc Cuong</b>
<b>Department of Diagnostic Imaging</b>

<b>Department of Diagnostic Imaging </b>

<b>INTRODUCTION</b>

<b>CONTENT</b>

<b>DISCUSSION</b>
<b>TECHNIQUE</b>
<b>CASE</b>

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 <b>Cererospinal fluid (CSF) leak may occur from the nose, from the</b>
<b>external auditory canal. This is a serious complication lead to</b>
<b>meningitis, nervous disorder…</b>

<b>INTRODUCTION</b>

 <b>Causes: trauma, skull base fractures, brain tumor, inflamed sinuses,</b>
<b>operation accident…</b>

 <b>Report a patient who was diagnosed CSF leak after an operation with</b>
<b>diagnosis of inflamed sinuses and nasal polyp.</b>

 <b>Male, 58 years old</b>

 <b>After operation with diagnosis of</b>
<b>inflamed sinuses and nasal polyp.</b>

<b>CASE</b>

<b>inflamed sinuses and nasal polyp.</b>

 <b>Leak fluid from the nose</b>



 <b>CTCT scan,scan, MRI,MRI, ENTENT endoscopyendoscopy</b>
<b>without</b>

<b>without</b> <b>detectingdetecting</b> <b>thethe</b> <b>leakingleaking</b>
<b>position</b>

<b>position..</b>

<b>f</b> <b>i</b>

 <b>Performing the Myelography at the</b>
<b>Department of Diagnostic Imaging,</b>
<b>Militay Central Hospital 108</b>

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<b>Myelography</b>

<b>Myelography isis mostmost commonlycommonly usedused toto detectdetect abnormalitiesabnormalities affectingaffecting</b>
<b>the</b>

<b>the spinalspinal cord,cord, thethe spinalspinal canal,canal, thethe spinalspinal nervenerve rootsroots..</b>

<b>TECHNIQUE</b>



 <b>PREPARATIONPREPARATION</b>

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<b>TECHNIQUE</b>

<b>The lower lumbar spial </b>

<b>The lower lumbar spial canal </b>

<b>canal </b>

<b>L3</b>

<b>L3 L4</b>

<b>L4 L4</b>

<b>L4 L5</b>

<b>L5</b>

<b>TECHNIQUE</b>

<b>L3</b>

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<b>CONTRAST MATERIALS</b>

<b>Mixed Omnipaque/ Physiological saline or distilled water:</b>

<b>Mixed Omnipaque/ Physiological saline or distilled water:</b>

<b>7 ml / 3 ml or </b>

<b>7 ml / 3 ml or </b>

<b>8 ml / 2 ml</b>

<b>8 ml / 2 ml</b>

<b>TECHNIQUE</b>

<b>Low head</b>

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<b>TECHNIQUE</b>

<b>After 20-30 mins, take CT scan</b>

<b>TECHNIQUE</b>

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<b>TECHNIQUE</b>

<b>- Myelography scan: from the </b>

<b>top skull to chin, slide thickness </b>

<b>of 3,75 mm - reconstruct 0,625 </b>

<b>mm. </b>

<b>IMAGES</b>

<b>- The leaking position at the cribriform plate of ethmoid bone.</b>

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

<b>Cerebrospinal fluid</b>

<b>surrounds and protects the brain and the</b>

<b>spinal cord, which make up the central nervous system.</b>

<b>DISCUSSION</b>



<b>CSF leak</b>

<b>may lead to meningitis, even death belongs to causes</b>

<b>and positon of CSF leak. Also, diagnosis CSF leak early</b>

<b>determines treatment and prevents the complications.</b>



<b>The myelography technique</b>

<b>is indicated for patients with</b>

<b>suspicion of CFS when other methods such as CT, MRI or ENT</b>

<b>endoscopy could not find out the leaking postion.</b>

•

<b>Dural tear</b>

<b>H</b>

<b>d</b>

<b>h</b>

<b>RISKS</b>

•

<b>Headache</b>

•

<b>Inflammation</b>

•

<b>Meningitis</b>

•

<b>Epidural Abscess</b>

•

<b>Anaphylaxis</b>

<b>p y</b>

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•

<b>Take a rest, drink water</b>

<b>MONITORING</b>

•

<b>The head and shoulder elevated at 30-45 degrees</b>

•

<b>Lying on the bed for hours</b>

•

<b>Injected position.</b>

•

<b>The Myelography technique is a valuable method to detect </b>

<b>CONCLUSION</b>

<b>the CSF leak when other methods such as CT, MRI or ENT </b>

<b>endoscopy could not find out the leaking postion.</b>

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<b>THANK YOU </b>

<b>THANK YOU </b>

<b>FOR YOUR ATTENTION!</b>

<b>FOR YOUR ATTENTION!</b>

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