Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site. All patients had significant improvement in their headache intensity. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. ![]() Mean time to targeted epidural patches with fibrin sealant was 4.5 years. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Treatment response at return visit (3 months post-patch) was documented. Targeted epidural patches with fibrin sealant were performed. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. ![]() Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches.
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