The frequency of cerebrospinal fluid (CSF) rhinorrhea is determined by the underlying etiology. Sagittal magnetic resonance cisternogram demonstrates the connection of the meningocele to the middle cranial fossa; this finding facilitated surgical planning. Miss Emily Ann King WedsMr. Craig Anthony Przyborski CSF fistula can usually be demonstrated by using some method of cisternography. Please try again soon. The resulting communication with the central nervous system (CNS) can result in a multitude of infectious complications that impart significant morbidity and potentially disastrous long-term deficits for the patient. This website also contains material copyrighted by 3rd parties. Epub 2018 Sep 24. Kim DH, Kim SW, Han JS, Kim GJ, Basurrah MA, Hwang SH. Beta2-transferrin assay is currently single best laboratory test for identifying the presence of CSF in sinonasal fluid. [QxMD MEDLINE Link]. 2016 Jan. 206 (1):8-19. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defects: a review of twenty-nine cases. In radiology, the halo sign is a finding of a dark halo around the arterial lumen on ultrasound that suggests the diagnosis of temporal arteritis. CT scans may demonstrate skull base defects resulting from accidental or iatrogenic trauma, an underlying anatomic or developmental abnormality, or an erosive lesion such as a neoplasm. Lucien M Levy, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, American Society of Neuroradiology, Radiological Society of North AmericaDisclosure: Nothing to disclose. [QxMD MEDLINE Link]. 2016 Jan;6(1):8-16. doi: 10.1002/alr.21637. Doublering sign in granulocyte colonystimulating factorinduced Several texts have suggested that CSF will separate from blood when the mixture is placed on filter paper or other media and will produce a clinically detectable sign, which has been referred to as a ring sign, double ring sign, or halo sign. Magnetic resonance myelogram demonstrates pseudomeningoceles secondary to a stretch injury of the lumbosacral nerve roots. Hence, the surgical team should be prepared to repair the resulting CSF leak at the time of the resection, either transcranially or endoscopically. All rights reserved. In patients undergoing endoscopic sinus surgery, the site of injury is most frequently the lateral lamella of the cribriform plate, where the bone of the anterior skull base is thinnest. Coronal fast spin-echo T2-weighted image demonstrates herniation of meninges and brain tissue (arrows) with adjacent cerebrospinal fluid into the postmastoidectomy tegmen tympani defect. L Gill Naul, MD Professor and Head, Department of Radiology, Texas A&M University College of Medicine; Chair, Department of Radiology, Baylor Scott and White Healthcare, Central Division Double ring sign | definition of double ring sign by Medical dictionary Perform high-resolution, thin-section axial and coronal cranial and facial computed tomography (CT) scanning. Adv Med Sci. 1994 Nov. 111(5):600-5. When there is doubt about the origin of the blood, the diagnosis of a basilar skull fracture must be excluded. Am J Rhinol Allergy. Various other authors, including Dohlman (1948), Hirsch (1952), and Hallberg (1964), subsequently reported successful repair of CSF rhinorrhea through different external approaches. Double-ring sign in granulocyte colony-stimulating factor-induced Each patient subsequently underwent a procedure for an epidural blood patch, and all patients experienced symptomatic relief. 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). If CSF is present, a dextrose stick test may be positive. [6] Include all of the paranasal sinuses and petrous temporal bones in the scans. Triplanar images of a patient with a left lateral recess meningoencephalocele. Coronal CT image of the temporal bone demonstrates a bone defect (small arrows) in the tegmen tympani with a protruding soft-tissue meningoencephalocele (large arrows). Eljamel MS, Pidgeon CN, Toland J, et al. 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. [16] Contemporary computer-reconstructed coronal images are usually of diagnostic quality, and direct CT coronal images may not be necessary. The result will form two distinct rings, called a "target" or "double ring" sign. Spontaneous CSF rhinorrhea occurs in patients without antecedent causes. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Optic nerve deficits suggest a lesion in the region of tuberculum sellae, sphenoid sinus, or posterior ethmoid cells. eCollection 2023. Br J Neurosurg. 32(5):832-8. The test for CSF fluid involves placing a sample of what the doctor suspects to be CSF discharge on a piece of filter paper. MRI in the Localization of CSF Fistulae: Is It of Any Value?. These nsignatures together form a ring signature on behalf of pk. government site. [QxMD MEDLINE Link]. The result will form two distinct rings, called a "target" or "double ring" sign. He had been wearing a seat belt. Fleischman GM, Ambrose EC, Rawal RB, et al.
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