The blood patch is usually applied to the lower back at the level of the 3rd/4th lumbar vertebra. In this procedure, the patient's own blood, which was taken from a vein shortly beforehand, is injected into the space around the spinal cord membranes (epidural space). If no spontaneous closure of the CSF fistula occurs through bed rest, the next step is a so-called blood patch. Bed rest and caffeine (only during the initial stage for a few days).Dynamic myelo-computed tomography of the target region with special technique *.Post-myelo computed tomography with early images and late images if necessary.Dynamic myelography with special tilting table, if necessary intubated as digital subtraction myelography.Lumbar puncture with opening pressure and computerized infusion test.Spinal MRI with intrathecal contrast imaging (in selected cases).Dynamic (standing and lying) ultrasound examination of the optic sheath.Special sequences of cranial and spinal MRI.Depending on the findings, individual steps can be skipped or additional examinations can be ordered: We have developed a special step-by-step diagnostic protocol at Inselspital to answer both questions, which is performed with enormous care and in a highly standardized manner by a specialized and experienced neuroradiologist. In addition, there are so-called "false-localizing signs", i.e. It is precisely at this point that many examinations in other clinics fail, since conventional examinations usually conceal the leak. The most challenging part is actually finding this tiny tear and localizing it to the millimeter throughout the spine. the defect in the dura from which the CSF escapes? The second question is even more important: Where exactly is the CSF fistula located, i.e. In this way, one knows with relative certainty that CSF is really draining. If direct detection is not possible, the diagnosis can be confirmed indirectly using other methods, such as ultrasound of the optic nerve or measurement of the outflow resistance of the CSF. In addition to conventional myelography, a combination with myelo-computed tomography (myelo-CT) is also possible. a radiological contrast image of the spinal canal, is performed. If the findings are negative, a myelography, i.e. This is usually done by magnetic resonance imaging (MRI). This first needs to be confirmed with certainty. The initial question is: Is cerebrospinal fluid actually leaking through a crack in the dura?
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