double ring sign csf

Copyright 2023, CMA Impact Inc.or its licensors. [QxMD MEDLINE Link]. This website also contains material copyrighted by 3rd parties. Physical examination should include complete rhinologic (including endoscopic), otologic, head and neck, and neurologic evaluations. Methods: 34(7):410-6. Please confirm that you would like to log out of Medscape. Eljamel MS, Pidgeon CN, Toland J, et al. Respir Med Case Rep. 2023 Feb 11;42:101814. doi: 10.1016/j.rmcr.2023.101814. HHS Vulnerability Disclosure, Help For more information, see the eMedicine topic Nephrogenic Systemic Fibrosis. [QxMD MEDLINE Link]. doi: 10.1371/journal.pntd.0004516. However, most of the time physical examination is unrevealing, especially in patients with intermittent CSF rhinorrhea. AJNR Am J Neuroradiol. Observe with a Wood lamp 30 minutes later for fluorescence of nasal discharge; if present, this confirms CSF . [4], CT cisternography or radionuclide cisternography may be useful if CT and MR cisternography do not show the CSF fistula. 2005;38[4]:597), an elegant study from 1993 shows the double ring sign is neither sensitive nor specific for CSF. Ray BS, Bergland RM. Cisternography with an intrathecal injection of radioisotope or nonionic iodinated myelographic contrast medium or MRI cisternography usually localizes the CSF leak. Arch Otolaryngol Head Neck Surg. High-Resolution Computed Tomography as an Initial Diagnostic and Localization Tool in Patients with Cerebrospinal Fluid Rhinorrhea: A Meta-Analysis. 30 (6):424-9. [QxMD MEDLINE Link]. Burns BJ. [QxMD MEDLINE Link]. Dodson EE, Gross CW, Swerdloff JL, et al. Clinical Radiology. [QxMD MEDLINE Link]. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review If an iatrogenic leak is detected intraoperatively, it should be repaired at the time of the original surgery. PDF DualRing: Generic Construction of Ring Signatures with E cient If the defect is large, brain parenchyma may also herniate through the defect (encephalocele). Subdural hygroma or hematoma on the cerebral convexities is common. Cerebrospinal fluid (CSF) rhinorrhea is a rare but potentially devastating condition that can lead to significant morbidity and mortality for the patient. A large defect is noted, and the meningocele has been resected. Neurosurgery. Penetrating and closed-head trauma are responsible for 90% of all cases of CSF leaks. Each patient subsequently underwent a procedure for an epidural blood patch, and all patients experienced symptomatic relief. You are being redirected to Small series of patients had no apparent adverse effect from the gadolinium contrast medium. Neurosurgery. In one study of 45 patients, CT of the skull and facial bones with high-resolution, thin-section axial and coronal images had an accuracy of 92%, a sensitivity of 92%, and a specificity of 100% in depicting the presence or absence of CSF fistula. 2008 Jan. 29(1):116-21. Ryall RG, Peacock MK, Simpson DA. This finding is consistent with a meningoencephalocele of the temporal bone. Double ring sign (CSF leak) If ring sign test is positive, which drugs are restricted? 2022. 2022 Dec 8;12(12):1685. doi: 10.3390/brainsci12121685. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. However, if CSF rhinorrhea persists beyond this point, or if a large skull base defect is observed at the time of injury, surgical repair is warranted. 2006; [1]:CD004884.) 1-7. Another Na+/K+ ATPase lining the ventricular side of the epithelium extrudes Na+ into the ventricle, with water following across this ionic gradient. CSF Rhinorrhoea - www.medicoapps.org Also, it serves as nutrient delivery and waste removal system for the brain. Quick Consult: Symptoms: Head Injury and Confusion after a The embryologic defect is typically a patent fonticulus frontalis or foramen cecum. Clipboard, Search History, and several other advanced features are temporarily unavailable. All of these changes are reversible with ablation of the cause of CSF leak, which is usually in the spine. The dura of the anterior cranial base is subject to wide variations in CSF pressure because of several factors, including normal arterial and respiratory fluctuations. (Ann Emerg Med. A control pledget for lacrimal secretions is placed under one inferior nasal turbinate. Find many great new & used options and get the best deals for DOUBLE HEART FILIGREE .925 Sterling SILVER Ring - 1.5g Size 7.5 at the best online prices at eBay! Cerebrospinal fluid (CSF) leaks are generally classified as traumatic, iatrogenic, and spontaneous/idiopathic. DeConde AS, Suh JD, Ramakrishnan VR. Nadieska Caballero, MD Fellow in Rhinology and Skull Base Surgery, Sinus and Nasal Institute of Florida Since then, endoscopic repair has become the preferred method of addressing CSF rhinorrhea, given the high success rate of 90-95% and the decreased morbidity associated with this approach. Alternatively, with the patient lying prone on a stretcher, the patient's hips can be raised above the level of the head for 1-2 minutes to concentrate the contrast medium over the anterior and posterior regions of the skull base. Skull base injuries can vary from simple cracks in the bony architecture to large (>1 cm) defects with disruption of the dura and potentially brain parenchyma. When this happens, you can get a double ring sign (also called the halo, target, or ring sign). The 'Ring Sign': Is it a reliable indicator for cerebral spinal fluid? How to detect csf leak? - Dane101 4 5 7 Immunofixation electrophoresis is the Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Li L, Gao FQ, Zhang B, Luo BN, Yang ZY, Zhao J. Overdosage of intrathecal gadolinium and neurological response. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. The https:// ensures that you are connecting to the The leakage stops within 1 week in 70% of patients, within 3 months in 20-30%, and within 6 months in most patients. Nadieska Caballero, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic SocietyDisclosure: Nothing to disclose. Otolaryngology and Facial Plastic Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American Academy of Facial Plastic and Reconstructive Surgery. Cerebrospinal fluid (CSF) is a clear fluid that surrounds your brain and spinal cord. 2015 Oct 14. 1969 Apr. Rarely, the leak can originate in the middle or posterior cranial fossa and can reach the nasal cavity by way of the middle ear and eustachian tube. AJNR Am J Neuroradiol. Elmorsy SM, Khafagy YW. Matsumura A, Anno I, Kimura H, Ishikawa E, Nose T. Diagnosis of spontaneous intracranial hypotension by using magnetic resonance myelography. Bharucha T, Chanthongthip A, Phuangpanom S, Phonemixay O, Sengvilaipaseuth O, Vongsouvath M, Lee S, Newton PN, Dubot-Prs A. PLoS Negl Trop Dis. G-CSF-induced vasculitis has been reported to occur in 0.47% of patients. Another advantage is the ability to more accurately position underlay or overlay grafts. MR cisternography may demonstrate inactive CSF fistulas. [4], For this specialized laboratory study, 0.5-1.0 mL of the fluid may be required. The cerebral ventricles may be reduced in size, and the pituitary gland may appear enlarged. Beta-2 transferrin is the most reliable confirmatory test for CSF leak. Outcomes of outpatient endoscopic repair of cerebrospinal fluid rhinorrhea. 63 (2):197-201. Reddy M, Baugnon K. Imaging of Cerebrospinal Fluid Rhinorrhea and Otorrhea. CSF rhinorrhoea: the place of endoscopic sinus surgery. To study the development of a ring sign when blood is mixed with various fluids. The frequency of cerebrospinal fluid (CSF) rhinorrhea is determined by the underlying etiology. [QxMD MEDLINE Link]. HEAD AND FACIAL TRAUMA | Anesthesia Key 2 However, the sign was not specific to CSF: mixtures of blood with saline, tears or rhinorrhea also produced halos; filter paper, paper towel, coffee filters and linen all 1998 Apr. A 27-year-old male driver in a single-vehicle rollover collision was transferred to a trauma centre after stabilization and endotracheal intubation at a community hospital. Spinal cerebrospinal fluid leaks detected by radionuclide cisternography and magnetic resonance imaging in patients suspected of intracranial hypotension. A systematic review of the literature was performed using PubMed, EMBASE, and Cochrane databases from January 1990 through September 2014, to examine 9 diagnostic and localization modalities for CSF rhinorrhea. 19(4):627-31. Please try after some time. Leakage of CSF due to trauma or basilar skull fracture Halo test/double ring sign + (paper) How to test for CSF rhinorrhea urine dipstick: glucose (=CSF) paper: + halo test/double ring sign CSF rhinorrhea treatment Surgical repair of skull defect Auricular hematoma Blood between cartilage and perichondrium 2002 Feb. 44(2):143-50; discussion 151-2. Computed tomography (CT) of the patients head showed, among other injuries, a transverse fracture of the petrous segment of his right temporal bone (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.120055/-/DC1). For more information, see Medscape. Federal government websites often end in .gov or .mil. Most of the patients (95%) with a delayed CSF leak present within 3 months after the injury. 2009 Oct. 72(4):341-5; discussion 346. From the first intracranial repair in the 1900s to the use of endoscopes and image-guidance systems, the management of cerebrospinal fluid (CSF) rhinorrhea has greatly evolved. Int Forum Allergy Rhinol. Yousry I, Forderreuther S, Moriggl B, et al. Adams AS, Francis DO, Russell PT. Follow-up 48- or 72-hour scans are possible with 111In and may be useful in the detection of intermittent CSF fluid leaks. El Gammal T, Sobol W, Wadlington VR, et al. Would you like email updates of new search results? Any surgical manipulation near the skull base can result in an iatrogenic CSF leak. Slow CSF leaks may be detected by postmyelogram CT scan in which there is a time delay between the contrast medium intrathecal injection in the fluoroscopic room and subsequent transfer to the CT scan room. CT myelography is used in the detection of spinal CSF leak. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. After transfer, a bloody discharge was noted from his right external auditory canal, and the right tympanic membrane was perforated. Ann Nucl Med. The management of CSF rhinorrhea depends on the cause, location, and severity of the leak. How . A thorough history is the first step toward accurate diagnosis. This terminology seems to imply that spontaneous CSF leaks are idiopathic in nature; however, recent evidence has led us to realize that spontaneous CSF rhinorrhea may in reality be secondary to an intracranial process, namely elevated intracranial pressure (ICP). Radionuclide cisternography may be useful to detect an intermittently active CSF fistula. 2018 Dec;38(4):1384-1392. doi: 10.1088/1361-6498/aae39b. Typical imaging parameters include a repetition time of 10,000 ms, an effective echo time of 200 ms, 4 signals acquired, an echo train length of 16, a matrix of 512 X 192, no phase-wrap option, 3-mm sections interleaved contiguously (0-mm gap), and a 16-cm field of view. [QxMD MEDLINE Link]. Carbonic anhydrase catalyzes the formation of bicarbonate inside the epithelial cell. On occasion, the patient has a history of headache relieved by drainage of CSF. Your message has been successfully sent to your colleague. The fluid can be placed on filter paper and a "halo" or double ring may be seen. A biopsy should never be obtained unless a complete imaging workup has been conducted. 1993:22[4]:718.). 2008 Mar-Apr. Spelle L, Boulin A, Tainturier C, Visot A, Graveleau P, Pierot L. Neuroimaging features of spontaneous intracranial hypotension. Medicina (Kaunas). Ask about Metformin Anyway, Special Report: Tackling the Behavioral Health Boarding Crisis, Evidence-Based Medicine: Ditch Diphenhydramine for Headache, Emergency Medicine Practice: The Future is Bright (Because We're in Flames), Quick Consult: Symptoms: Head Injury and Confusion after a Fall, Privacy Policy (Updated December 15, 2022). The investigators suggested that intracranial hypertension may put patients at risk for developing these defects. (See images below.). A case of cerebrospinal fluid rhinorrhoea: a surgical challenge. Double-ring sign in granulocyte colony-stimulating factor-induced 2014 Jul;15(4):363. doi: 10.5811/westjem.2014.4.21346. A doctor can use a number of tests to diagnose a CSF leak. Basal skull fracture and the halo sign | CMAJ Conclusion: Adams AS, Russell PT, Duncavage JA, Chandra RK, Turner JH. 33:690-94. Dr. Kaplan responds: Thank you so much for your thoughtful reply to my article. This site needs JavaScript to work properly. your express consent. Endoscopy may reveal an encephalocele or meningocele. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defects: a review of twenty-nine cases. Most spontaneous, or primary, causes of CSF rhinorrhea are now thought actually to be secondary to elevations in intracranial pressure (ICP) that might be seen in patients with idiopathic intracranial hypertension (IIH). Cerebrospinal Fluid (CSF) Leak | Choose the Right Test - ARUP Consult Other proposed mechanisms for nontraumatic CSF leaks include focal atrophy, rupture of arachnoid projections that accompany the fibers of the olfactory nerve, and persistence of an embryonic olfactory lumen. Some otolaryngologists use a dilute solution of fluorescein to localize CSF fistulas both preoperatively and during surgery. One or more CSF fistulas may originate from spinal nerve root sleeves in the case of spontaneous spinal CSF leak. Share cases and questions with Physicians on Medscape consult. 2015 Sep 15. Marchiano E, Carniol ET, Guzman DE, Raikundalia MD, Baredes S, Eloy JA. [QxMD MEDLINE Link]. [Full Text]. 8(4):433-7. In contrast to traumatic leaks, only 50% of patients with iatrogenic CSF leaks present within the first week after the insult. Intrathecal gadolinium-enhanced MR cisternography in the evaluation of clinically suspected cerebrospinal fluid rhinorrhea in humans: early experience. This sign appears when CSF mixes with blood on an absorbent surface, such as paper or bed sheets, and creates a double ring pattern. Utility of preoperative high-resolution CT and intraoperative image guidance in identification of cerebrospinal fluid leaks for endoscopic repair. Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck SocietyDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10
Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)
Received ownership interest from Cerescan for consulting for: Neosoma, MI10. Fluid leaking from the nose or external auditory canal must first be positively identified as CSF. Lucien M Levy, MD, PhD 2015 Apr 28. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. [8]. Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review. [QxMD MEDLINE Link]. 1 The double-ring sign, which reflects inflammatory changes in the adventitia and oedema of the intima, is thought to be characteristic of Takayasu arteritis (TA . National Library of Medicine Case report. Sign in 0 Cart; Gifts for Mom; Jewelry & Accessories . Miss Ashley Field Weds Mr. Justin Kahn The enzyme B2Tr is produced in the brain by neuraminidase activity and is present in CSF, perilymph, and ocular aqueous humor but not in sinonasal mucous secretions and tears. According to another theory, the tear and bony defect are present from the time of the original injury, but the leak occurs only after the masking hematoma dissolves. [QxMD MEDLINE Link]. Kreatsoulas DC, Shah VS, Otto BA, Carrau RL, Prevedello DM, Hardesty DA. Other local services are: Electrical . Skull Fracture - FPnotebook.com Temporal lobe gyral herniation may occur through a petrous temporal bone tegmen tympani defect. Background: Careers. Repair of the leak can be performed with an underlay fascia graft and an anterior-based pedicled mucosa flap. Meningoencephaloceles usually present in childhood as an intranasal/extranasal mass that transilluminates and expands with crying (Furstenberg sign). Albu S, Florian IS, Bolboaca SD. Additionally, a mixture of at least 30 percent CSF to blood was required to produce a double ring sign reliably, so the absence of a double ring sign does not exclude a CSF leak. The probe indicates that access to the defect is performed through the maxillary sinus and pterygopalatine fossa. Br J Neurosurg. Double Ring Sign (on bedding, paper) CSF Leakage will form appearance of watermelon in cross section Large Inner ring of pink, bloody CSF fluid Small outer ring of clear CSF fluid (analogous to the rind of a watermelon) Bedside Glucose of draining fluid CSF fluid will have bedside Glucose >30 mg/dl IV. [QxMD MEDLINE Link]. J Neurol Neurosurg Psychiatry. CSF represents the end product of the ultrafiltration of plasma across epithelial cells in the choroid plexus lining the ventricles of the brain. government site. A small cribriform plate encephalocele is observed only after removing the middle turbinate. An absorptive sponge pad placed at or near the presumed site of fluid leak can facilitate the collection of the fluid. Detection of Cerebrospinal Fluid Leaks Using the Endoscopic Fluorescein Test in the Postoperative Period following Pituitary and Ventral Skull Base Surgery. (See images below.). B2Tr may be found in blood serum in liver disease, such as in chronic alcoholism and in patients with inborn errors of glycoprotein metabolism or genetic variants of transferrin. Typically, 0.5 mL of a 10% fluorescein solution is injected into the lumbar subarachnoid space over more than 1 minute. Results: MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension. Doublering sign in granulocyte colonystimulating factorinduced Various other authors, including Dohlman (1948), Hirsch (1952), and Hallberg (1964), subsequently reported successful repair of CSF rhinorrhea through different external approaches. Europe PMC is an archive of life sciences journal literature. Conclusion: Is acetazolamide really useful in the management of traumatic cerebrospinal fluid rhinorrhea?. Skull Fracture Goel G, Ravishankar S, Jayakumar PN, et al. 2008 Sep. 63(9):1063-8. Brain Sci. Lieberman SM, Chen S, Jethanamest D, Casiano RR. Doublering sign in granulocyte colonystimulating factorinduced These cases often lead to a misdiagnosis of allergic and vasomotor rhinitis. Teachey W, Grayson J, Cho DY, Riley KO, Woodworth BA. Lu X, Zhai X, Li H, Yang X, Hang W, Liu G. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. Double Finger Ring - Etsy No double ring sign was identied using this test. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. encoded search term (Cerebrospinal Fluid Leak Imaging) and Cerebrospinal Fluid Leak Imaging, Plastic Surgery for Frontal Sinus Fractures, Plasma Biomarkers and Genetics in the Diagnosis and Prediction of Alzheimer's Disease. One test involves placing a sample of what the doctor suspects to be CSF discharge on a piece of filter paper . [QxMD MEDLINE Link]. Study objective: 2nd edition. CSF fistula can usually be demonstrated by using some method of cisternography. Clin Nucl Med. [17, 18] (See images below.). Clinical images are chosen because they are particularly intriguing, classic or dramatic. [QxMD MEDLINE Link]. Ideally, the contrast medium is concentrated in the intracranial anterior and posterior skull base regions under fluoroscopic guidance by tilting the prone patient head downward on a fluoroscopic tilt table. Axial fast spin-echo T2-weighted MRI demonstrates widened extra-axial fluid spaces but no focal extra-axial fluid collection. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience. Arterial injury may occur with skull trauma that causes CSF leakage. [QxMD MEDLINE Link]. Although the value of this sign has been debated, an experiment showed that the sign was consistently visible when CSF concentrations were 30%90% when mixed with blood.2 However, the sign was not specific to CSF: mixtures of blood with saline, tears or rhinorrhea also produced halos; filter paper, paper towel, coffee filters and linen all showed a ring.2, Guidelines recommend a CT scan of the head when basal skull fracture is suspected.3 Although CSF leakage occurs in 2%21% of basal skull fractures, a recent review does not support the use of prophylactic antibiotics to prevent the development of meningitis.4. Otolaryngology procedures, including FESS and septoplasty, can lead to a skull base defect and CSF rhinorrhea. 2003 Aug. 129(8):859-63. [QxMD MEDLINE Link]. The images may demonstrate a CSF fistula, but this technique is used less frequently than other cisternographic methods. Endoscopic Endonasal Skull Base Surgery Complication Avoidance: A Contemporary Review. Otolaryngol Head Neck Surg. Cervical MR imaging in postural headache: MR signs and pathophysiological implications. Magnetic resonance cisternography (MRC) should be used for CSF leak identification as a second line for each of these if beta-2 transferrin is not available or if HRCT is ambiguous. 2015 May. The CSF double ring sign is based on the principle that blood and CSF will disseminate at different rates, due to different uid densities, creating a ''double ring,'' one of blood, [24] Most MRI machines offer fat suppression and image gray-scale reversal. ENT emergencies Flashcards | Quizlet These nsignatures together form a ring signature on behalf of pk. A defect in the skull base is measured with a sterile ruler. In patients with nonsurgical trauma, waiting a period of 5-7 days to allow conservative measures (bed rest, stool softeners, and lumbar drainage) to assist with secondary closure of the traumatic defect is reasonable. Radionuclide cisternography is performed by administering a lumbar subarachnoid intrathecal injection of Indium-111 (111In) diethylenetriamine pentaacetic acid (DTPA) in a 500 Ci dose. 22(4):718-20. and transmitted securely. Methods: J Neurosurg. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. You may be trying to access this site from a secured browser on the server. Coronal CT images of 2-3 mm thickness are then obtained through the face and cranium, including all of the paranasal sinuses and the mastoid air cells. Surg Neurol. From the Department of Emergency Medicine (Sunder), Royal Inland Hospital, Kamloops, BC; and the Department of Radiology (Tyler), Queens University, Kingston, Ont. The typical history of a cerebropsinal fluid (CSF) leak is that of clear, watery discharge, usually unilateral. Coronal and sagittal imaging is necessary. Traumatic cerebrospinal fluid leak. Higher-level studies are needed to better determine optimal diagnostic and clinical management approaches. Thank you for your interest in spreading the word on CMAJ. Fleischman GM, Ambrose EC, Rawal RB, et al. MR T2 myelography may demonstrate spinal CSF fistulas (see the images below). The sella turcica and sphenoid sinus are involved in 15% of the cases as well. Axial magnetic resonance cisternogram demonstrates the connection of the meningocele to the middle cranial fossa (arrows). sharing sensitive information, make sure youre on a federal Patients with recurrent meningitis, especially pneumococcal meningitis, should be evaluated for a defect that exposes the intracranial space to the upper airway, regardless of the presence or absence of CSF rhinorrhea. Epub 2018 Sep 24. [Diagnostic value of computed tomographic cisternography and magnetic resonance hydrography in cerebrospinal fluid rhinorrhea]. Traumatic causes include both blunt and penetrating facial injuries. [Full Text]. J Neurol Neurosurg Psychiatry. The intrathecal injection of gadolinium-based contrast media has been shown in several off-label studies to be effective and safe in selected patients in whom other cisternographic or myelographic studies have failed to demonstrate the CSF leak site. Enrique Palacios, MD, FACR is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Neuroradiology, Radiological Society of North AmericaDisclosure: Nothing to disclose. 32(5):832-8. 134:110044. C Douglas Phillips, MD, FACR is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Head and Neck Radiology, American Society of Neuroradiology, Association of University Radiologists, Radiological Society of North AmericaDisclosure: Nothing to disclose. Magnetic resonance cisternography (MRC) should be used for CSF leak identification as a second line for each of these if beta-2 transferrin is not available or if HRCT is ambiguous. Before 1990 Dec. 53(12):1072-5. Gadolinium-enhanced, coronal, T1-weighted MRI. The intrathecal injection of 0.5 mL of gadopentetate dimeglumine diluted in 3-5 mL of CSF for MR cisternography has been reported to have high sensitivity and specificity for detection of active CSF fistula, exceeding the rate of fistula demonstration by CT, nuclear medicine, or noncontrasted MR cisternography. Please enable scripts and reload this page. J Neurosurg. Laryngoscope. CT findings associated with cerebrospinal fluid leaks include fractures or other bone defects; meningocele; focal fluid accumulation in the ethmoid air cells; frontal, sphenoid, or maxillary sinuses or mastoid air cells; and, sometimes, pneumocephalus. may email you for journal alerts and information, but is committed 1994 Nov. 111(5):600-5. Certain neurosurgical procedures such as craniotomy and transsphenoidal pituitary resections are most commonly associated with an increased risk of CSF rhinorrhea. Lawrence SK, Delbeke D, Partain CL. Epub 2013 Jul 1. Double Ring Sign: CSF mixed with blood or nasal discharge forms two rings because CSF being a watery fluid invades linen more than blood called the double-ring sign, halo sign, or . 2016 Jan. 206 (1):8-19. Am J Rhinol Allergy. The ring sign: Is it a reliable indicator for cerebral spinal fluid? NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. In a study of 4 patients who underwent radionuclide cisternography, as well as MRI and/or CT, for suspected CSF leaks, Thomas et al found that radionuclide cisternography accurately detected and localized the leaks in all patients. [11, 12, 5, 7, 13], Methods for detecting CSF fistulas with intrathecal injections of dye pose a risk of chemical meningitis. 2014 Nov. 124 (11):2645-50. 1993:22[4]:718.) Chazen JL, Talbott JF, Lantos JE, Dillon WP.

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