A 26-year-old woman presented with symptoms of orthostatic headache for 1 year that temporarily improved after 2 nontargeted epidural blood patches. Despite this intervention, she had persistent radiologic signs of CSF hypotension (Figure 1) and multiple meningeal diverticula on conventional CT myelography (Figure 2, A and C). Ultrafast dynamic CT myelography confirmed only 1 T8-T9 right-side meningeal diverticula in the initial phases (Figure 2, B and D), with later opacification of the remaining diverticula. Surgical treatment resulted in symptom resolution.
Ultrafast dynamic CT myelography can identify ventral dural tears, leaking meningeal diverticula and CSF-venous fistula, with superior contrast and temporal resolution than MRI. Greater radiation exposure is necessary1,2 and should be balanced against diagnostic precision.
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- Received June 3, 2022.
- Accepted in final form September 15, 2022.
- © 2022 American Academy of Neurology