Type 4 CSF leak (SLEC-N). Type 4 CSF leak (SLEC-N). A, Schematic depiction of a distal nerve root sleeve dural tear occurring beyond the epidural compartment.

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Presentation transcript:

Type 4 CSF leak (SLEC-N). Type 4 CSF leak (SLEC-N). A, Schematic depiction of a distal nerve root sleeve dural tear occurring beyond the epidural compartment extravasating into the surrounding fascial planes and loose connective tissue without loculation or fistulization. B, CT of the head. Sagittal reformat in a patient negative for SLEC demonstrates large low-density (bilateral) subdural hemorrhages (asterisk). Note the prominent “venous distension sign” (short arrow) despite the large subdural hemorrhages. C, Axial CT image obtained 10–20 minutes post-DSM shows subtle extravasated contrast in the region of the right C8 nerve (arrow). Note that on this nondynamic CT (slightly degraded due to beam-hardening artifacts associated with the shoulders), there is little to help distinguish this extravasated contrast from a normal diverticulum. D, Subtracted image from a right-side-down decubitus DSM shows extravasation of contrast (arrows) into the paraspinal tissues from a leak along the mid-to-distal right C8 nerve root sleeve. R.I. Farb et al. AJNR Am J Neuroradiol 2019;40:745-753 ©2019 by American Society of Neuroradiology