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Spinal MRI indicating CSF leak in superficial siderosis

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T2-weighted spine MRI in axial (a) and sagittal (b) section shows a longitudinally extensive epidural CSF collection from T2 to T8 (E) with a large spike-like osteophyte at T5/T6 impinging on the dura (G). The CT myelogram (c) shows contrast in the epidural collection from a CSF leak adjacent to the osteophyte (G). Legend: (A) spinal cord coated with hemosiderin; (B) epidural fat, bright on T2; (C) dura posterior to cord; (D) intradural CSF surrounding cord; (E) epidural CSF collection; (F) dura anterior to cord; (G) osteophyte; (H) CSF pulsation artifact. (Source: Halmagyi GM, Parker GD, Chen L, et al. Progressive loss of hearing and balance in superficial siderosis due to occult spinal dural defects. Eur Arch Otorhinolaryngol 2023;280[2]:633-41. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)