Spontaneous CSF leak imaging

A and C are axial and coronal views, respectively, of T1-weighted brain MRI with contrast 2 days after the onset of orthostatic headache. B and D are axial and coronal views, respectively, of T1-weighted brain MRI with contrast 17 days after the onset, demonstrating diffuse pachymeningeal enhancement involving both supra- and infratentorial regions. E is an axial view of conventional T2-weighted spinal MRI at the level of T1-2, revealing epidural CSF collection surrounding the dural sac. F is an axial view of heavily T2-weighted MR myelography at the same level, demonstrating epidural CSF collection (arrowhead) and bilateral CSF leaks through the neuroforamina (arrow), which was hardly discernible on conventional T2-weighted images. G is an axial slice around C1 on heavily T2-weighted MR myelography, revealing high-cervical retrospinal CSF collection (arrowhead). H is a thick-slice longitudinal myelogram, which also reveals the high-cervical retrospinal CSF collection (arrow), as well as epidural CSF collections (arrowhead). (Contributed by Dr. Yen-Feng Wang.)