Glossary

Adhesive Arachnoiditis (AA)

A chronic inflammatory disease where scar tissue adheres to the arachnoid membrane, causing widespread symptoms and pain.

 

Atlanto-Axial Instability (AAI)

Is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) of the spine.

 

Advanced myelography

Myelographic techniques specifically developed for the investigation of spinal CSF leak that differs from conventional myelographic techniques in patient positioning, timing of imaging, or manner of intrathecal contrast administration. Typically, “advanced myelography” refers to fluoroscopy- or CT-based imaging techniques.

 

Anterior

Ventral, or front.

 

Arachnoid mater

The meningeal layer between pia mater and dura mater, which surrounds brain and spinal cord.

 

Bleb / Arachnoid Bleb

A herniation of the arachnoid lining that encloses a collection of extradural CSF, resulting from a dural tear or puncture.

 

Bending, Lifting, Twisting (BLT)

In order to prevent traction to the dura mater and promote healing, patients are often advised to avoid “BLT” (including any straining) following any procedure to repair a spinal CSF leak.

 

Cranio-Cervical Instability (CCI)

Characterized by excessive movement of the vertebra at the atlanto-occipital joint and the atlanto-axial joint located between the skull and C1 and C2.

 

Cervical

Referring to the uppermost section of spine, in the neck region.

 

Chiari Malformation

Congenital malformation in which the bottom of the brain (cerebellum) is crowded in the skull cavity, and forces the lower tips of the cerebellar hemispheres (tonsils) into the hole in the bottom of the skull (foramen magnum). Cerebellar tonsils may also be low in patients with spinal CSF leak.

 

CSF-lymphatic fistula (CLF)

A rare (though possibly underdiagnosed) cause of SIH where there is a direct communication between the spinal subarachnoid space and lymphatic vessels, allowing for the loss of CSF directly into the lymphatic system.

 

Craniotomy

Surgical removal of a section of bone from the skull (cranium) for the purpose of operating on the underlying tissues, usually the brain.

 

Cerebrospinal Fluid leak (CSF Leak)

Which can be either spinal or cranial. The Spinal CSF Leak Foundation focuses on awareness, support, and research solely for spinal CSF leak.

 

Computed tomography (CT)

A type of X-ray imaging.

 

Computed tomography angiogram (CTA)

CT imaging to visualize arteries.

 

Computed tomography venogram (CTV)

CT imaging to visualize veins.

 

Cerebrospinal Fluid-Venous Fistulas (CSF-VF)

Sometimes just called VFs, or CVFs.

 

Cerebral venous sinus thrombosis (CVST)

A more rare complication of spinal CSF leak characterized by a blood clot that forms in the brain’s venous sinuses.

 

Chronic PDPH (cPDPH)

Chronic PDPH patients are often referred to as cPDPH patients.

 

Dynamic CTM (D-CTM or dCTM)

Where serial imaging is performed while intrathecal contrast is migrating or changing in concentration. May be performed by using fluoroscopy or CT. Dynamic CT myelography performed to evaluate for dural tears is sometimes referred to as “ultrafast CTM.”

 

Decubitus myelography

A type of advanced myelography in which contrast is injected with the patient in decubitus position, and the patient is maintained in this position to promote dependent contrast layering along the lateral thecal sac. Decubitus myelography may be used in the investigation of CVFs or lateral dural tears. Imaging may be with fluoroscopy or CT.

 

Diverticula

An abnormal sac or pouch formed at a weak point in the wall of the dura mater

 

Dorsal

Medical term for ‘at the back’

 

Digital Subtraction Myelogram (DSM)

A type of advanced myelography involving imaging on an angiography table, with a subtraction mask acquired before contrast injection. Imaging is then carried out during active intrathecal injection of contrast. Subtracted images are generated to assess the flow of contrast within the thecal sac. May be used to evaluate the location of dural tears or to assess for CVFs. Positioning may be prone or decubitus. DSM is also a type of dynamic myelography.

 

Dura mater

Literally, “tough mother.” Also referred to as the dura. The outermost layer of meninges or connective tissue layers that surround brain and spinal cord.

 

Epidural blood patch (EBP)

An injection of blood into the epidural space. After conservative management such as bed rest and fluids, an epidural blood patch is a common first-line treatment for spinal CSF leak.

 

Ehlers-Danlos Syndrome (EDS)

A type of connective tissue disorder

 

Elliotts B

A solution sometimes administered during leak testing to mimic natural CSF

 

Eye Movement Desensitization and Reprocessing (EMDR)

A type of psychotherapy especially helpful for PTSD.

 

Epidural space

Space outside (epi) the dura within the spinal canal.

 

Eagle Syndrome (ES)

Also known as Styloid Syndrome, is characterized by an elongation of the styloid process or calcification of the stylohyoid ligament.

 

Epidural Steroid Injection (ESI)

An injection of steroid into epidural space.

 

Etiology

The cause of a disease or condition.

 

Endovascular embolization (EE or, sometimes referred to just as an “embolization”)

A minimally invasive procedure where an interventional radiologist uses a catheter guided by imaging to locate and treat a venous fistula in the spine. Using glue or coils, the fistula is blocked.

 

Fibrin glue

Fibrin sealant, a surgical sealant derived from pooled human blood and bovine blood.

 

Fistula

An abnormal connection between two bodily cavities.

 

Fluoroscopy

X-ray imaging in real time, used for procedures.

 

Gadolinium

Contrast agent commonly used in magnetic resonance imaging.

 

Intracranial pressure (ICP)

The pressure exerted by fluids such as CSF, inside the skull and on the brain tissue.

 

Intracranial Hypotension (IH)

Characterized by abnormally low pressure or volume in the skull (the latter is known as CSF hypovolemia) due to a reduction of CSF secondary to spinal CSF leak or shunt over-draining.

 

Iatrogenic

Caused by medical tests or treatment (for example: leaks caused by lumbar punctures would be considered iatrogenic).

 

Idiopathic Intracranial Hypertension (IIH)

Previously known as pseudotumor cerebri and/or benign intracranial hypertension, is a condition characterized by increased intracranial pressure in the skull and around the brain without a detectable cause. Some groups refer to it as IH (for non-idiopathic Intracranial Hypertension, but IH in the leak world refers to hypOtension, not hypERtension.

 

Intracranial Hypertension

High (hyper) pressure inside the head (cranium).

 

Intrathecal space

Also called subarachnoid space, the space under arachnoid layer of meninges, around brain and spinal cord, which contains CSF.

 

The Internal Vertebral Venous Plexus (IVVP)

A network of interconnected channels of veins located beneath the bony structures within the vertebral canal. These plexuses lack valves and rely on posture and respiration for drainage. Some patients may have CVFs in the IVVP. Advanced myelography, including PCCT myelography, might be needed to localize CVFs in this region

 

Laminectomy

Surgical removal of all or a portion of the lamina section of a vertebral bone.

 

Lateral decubitus

Lateral decubitus is a position often used in myelography. Lateral decubitus simply means lying on your side. Right lateral decubitus means lying on your right side, while left lateral decubitus means lying on your left side. 

 

Lateral-decubitus Digital Subtraction Myelogram (LD-DSM)

A type of DSM.

 

Loeys-Dietz Syndrome (LDS)

A type of hereditary connective tissue disorder

 

Lumbar-peritoneal shunt (LP Shunt)

A catheter that diverts CSF from the lumbar region of the spine to the abdominal cavity (peritoneal space), usually with a valve-like device.

 

Lumbar

Referring to lower section of spine, lower back region.

 

Marfan

Referring to Marfan Syndrome, a type of genetic disorder that affects connective tissue.

 

Mast Cell Activation Disorder (MCAD)

Though MCAS is more commonly used.

 

Mast Cell Activation Syndrome (MCAS)

A type of mast cell disorder where mast cells, a type of white blood cell, inappropriately and excessively release chemicals known as “mediators” into the blood stream.

 

Meningitis

Inflammation of meninges (may be chemical or infectious).

 

Magnetic Resonance Angiography (MRA)

Customarily performed with contrast, using MRI technology to create images of arteries in the body.

 

Magnetic Resonance Myelogram (MRM)

MR imaging of spine and spinal canal.

 

Magnetic Resonance Venography (MRV)

Customarily performed with contrast, using MRI technology to create images of veins and blood flow.

 

Myelogram

Spinal imaging that involves the injection of contrast into the intrathecal space. (Exception: MR myelography can be done with or without intrathecal contrast injection.)

 

New Daily Persistent Headache (NDPH)

A common spinal CSF leak misdiagnosis, NDPH is a diagnosis of exclusion (given when other conditions are ruled out and there is no better explanation for symptoms). It is a primary headache disorder.

 

Neurologist

Medical specialist in diseases of brain, spinal cord, and nerves.

 

Neuropathy

Peripheral nerve damage to sensory, motor, or autonomic nerves that results in symptoms such as numbness, tingling, pain, and weakness. There are many causes, including compression, injury, metabolic causes (like diabetes), toxins, drugs, and nutritional deficiencies.

 

Neuroradiologist

Medical specialist in neurologic radiology (imaging).

 

Neurosurgeon

Surgical specialist in diseases of brain and spine.

 

Non-targeted epidural blood patch

An epidural blood patch injected across a region of the spine rather than a specific target. This procedure may result in partial or complete symptom remission even when a spinal CSF leak is not identified.

 

Opening pressure (OP)

A measurement of pressure exerted by CSF at the moment a needle is inserted during a lumbar puncture.

 

Orthostatic

Caused by upright or erect posture. E.g: leak pain is often worse upright, and is in those instances considered orthostatic

 

Osteophyte

A bone spur

 

Occult Tethered Cord (OTC)

Characterized by a patient having signs and symptoms of tethered cord syndrome, but with normal neuroimaging. (Note: OTC can also refer to “Over the Counter” with respect to medication that does not require a prescription.

 

Papilledema

Swelling of the optic disc, visible on ophthalmoscopic examination of the eye, caused by increased intracranial pressure.

 

Photon-counting CT machine (PCCT)

A specialized imaging type that provides sub-millimeter imaging resolution with less noise and less radiation.

 

Post-dural puncture headache (PDPH)

A term often used in medical journals to describe the symptoms of patients who sustain a spinal CSF leak from a dural puncture. Chronic PDPH patients are often referred to as cPDPH patients.

 

Perineural cyst

Cerebrospinal fluid–filled cyst of a nerve root sleeve along the spine.

 

Phonophobia

Sensitivity to sound.

 

Photophobia

Sensitivity to light.

 

Pia mater

Literally, “tender mother.” The innermost meningeal layer surrounding the brain and spinal cord.

 

Pituitary hyperemia

When the pituitary gland in head is engorged with fluid.

 

Posterior

Dorsal, or back.

 

Postural Orthostatic Tachycardia Syndrome (POTS)

A dysfunction of the ANS characterized by orthostatic intolerance (symptoms when upright that are mostly relieved by lying down).

 

Prone

Face-down, horizontal position.

 

Pseudomeningocele

A pseudomeningocele is an abnormal collection of cerebrospinal fluid (CSF) that extends from the spinal canal into the surrounding soft tissue, often as a result of a tear in the dura mater. A bleb is a type of pseudomeningocele, but not all pseudomeningoceles are blebs.

 

Radicular

Pertaining to a nerve root distribution.

 

Radiculopathy

Compression or irritation of a nerve root which results in symptoms of numbness, pain, and/or weakness.

 

Rebound Intracranial Hypertension (RIH)

A complication characterized by increased CSF pressure that can occur after successful treatment of a spinal CSF leak and/or getting sealed.

 

Sacral

Referring to the lowest section of spine, in the pelvic region, below lumbar section.

 

Sacrum

Referring to the five fused sacral vertebrae below the lumbar region.

 

Scoliosis

Abnormal curvature of the spine.

 

Spinal longitudinal extradural CSF collection (SLEC)

A collection of CSF in the epidural space of the spine that is seen on MRI scans and indicating a potential spinal CSF leak. SLEC-P means SLEC-positive, and SLEC-N means SLEC- negative.

 

Spontaneous Intracranial Hypotension (SIH)

Featuring low CSF volume symptoms such as the ones found https://spinalcsfleak.org/symptoms

 

Superficial Siderosis (SS)

A rare neurological disorder characterized by iron deposition in the superficial layers of the brain and spinal cord. This condition typically arises from chronic bleeding into the subarachnoid space, often due to previous head or spinal trauma, tumors, or vascular malformations, but can also be a rarer long-term consequence of spinal CSF leak. It is more often found in ventral tears than other types of spinal CSF leak, per this study: https://www.neurology.org/doi/10.1212/WNL.0000000000012786

 

Subarachnoid space

Intrathecal space. The space under arachnoid layer of meninges, around brain and spinal cord, which contains CSF.

 

Suboccipital

The region of the head below the occipital bone, at the base of the skull where the head and neck meet. Many leak patients experience their worst pain in this area.

 

Supine

Face-up, horizontal position.

 

Syringomyelia

Disorder involving a fluid-filled cavity within the spinal cord.

 

Heavily T2-weighted MR sequences used to image the spinal thecal sac (T2-MRM)

Viewed either as planar imaging or as rotational MIP images. T2-MRM does not involve intrathecal injection of contrast agent.

 

Targeted epidural blood patch

An epidural blood patch injected at the site of a suspected spinal CSF leak.

 

Tarlov Cyst

Perineural cyst occurring most often in the sacral region of the spine.

 

Tethered Cord (TC)

A reference to Tethered cord syndrome, a neurologic disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column.

 

Thecal sac

Another name for the dura as a whole (also dural sac)

 

Thoracic

Section of spine in upper back region.

 

Trendelenberg

A position where the patient’s head is lower than their feet, often used in the context of spinal CSF leak care to help a patient determine if their symptoms are worse posturally

 

Transvenous Embolization (TVE)

One type of treatment for CSF venous fistulas (CVFs). See also Endovascular Embolization

 

Valsalva Maneuver

Forced effort to exhale with closed airway (either closed glottis or closed mouth and nose), which results in increased venous pressure in the chest and spine and increased intracranial pressure.

 

Ventral

Medical term for anterior or at the front of the body.

 

Vertebra

Individual bone of the spine or vertebral column.

 

Venous fistula (VF)

See CSF-venous fistula above.

 

Ventriculoperitoneal shunt (VP Shunt)

A catheter that drains CSF from the lateral ventricle of the brain to the abdominal cavity (peritoneal space), usually with a valve-like device.

 

Venous sinus stenosis (VSS)

A type of cerebral venous system disorder that obstructs venous blood outflow due to a narrowing of the brain’s larger veins.