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Volume 6, Issue 4(Suppl)
OMICS J Radiol, an open access journal
ISSN: 2167-7964
Medical Imaging and Clinical Research 2017
September 11-12, 2017
September 11-12, 2017 | Paris, France
2
nd
World Congress on
Medical Imaging and Clinical Research
MR myelography for postoperative orthostatic headache
Chih-Jen Hung, Mu-Jung Lee
and
Gou-Rong Chiang
Taichung Veterans General Hospital, Taiwan
W
e report the case of a man who presented with orthostatic headache postoperatively. The procedure of mid-thoracic epidural
catheterization for posthoracotomy pain management was performed before induction of anesthesia. Unfortunately, the
procedure was abandoned due to some fluid aspirated from the epidural catheter. After operation, the patient complained of a severe
headache for the first time when he was in the upright position. However, the findings of magnetic resonance (MR) myelography
were characteristic of spontaneous intracranial hypotension (SIH), and the patient was successfully treated by an epidural blood
patch at T1 level. Some reports implied that epidural anesthesia/analgesia might be a possible triggering factor of SIH in patients
with an underlying structural weakness of spinal meninges. MR myelography can detect the pooling of CSF leakage. The T2-weighed
MR image of our patient revealed dural sinus engorgement with contrast enhancement along bilateral nerve root sleeves of 5 levels
from C7-T1 toT5-6 and left nerve root sleeve of C6-7 which indicated the presence of multiple simultaneous leaks at different spinal
levels. The present case suggests that MR myelography could be carried out in patients with postoperative orthostatic headache when
accidental dural puncture was not confirmed.
Biography
Chih-Jen Hung has his expertise in evaluation and passion in improving the health and wellbeing. He has worked both as Anesthesiologist and Pain Physician
for a couple of decades. Based on the clinical experience of thoracic epidural analgesia for postoperative pain management, he tries to improve the practice of
postoperative care and promote the education on the postoperative pain management.
hung@vghtc.gov.twChih-Jen Hung et al., OMICS J Radiol 2017, 6:4(Suppl)
DOI: 10.4172/2167-7964-C1-012
Figure 1: T2-weighed MRI revealed contrast enhancement
along neural sleeves of C7-T1.
Figure 2: Many CSF leak lesions along multiple nerve root
sleeves