• Saeed Fakhran, Stacy Palfey, Andrew Thomas, Samuel Schwarz, and Lea Alhilali.
• Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, fakhrans@upmc.edu.
• Eur Radiol. 2014 Apr 1;24(4):827-33.

ObjectivesTo determine if nerve root sleeve diverticula or CSF leakage correlate with post-dural puncture headache (PDPH).MethodsA total of 781 lumbar and 408 cervical post-myelogram CTs were reviewed using a total diverticulum and leakage (TDL) score: 1, nerve root sleeve diverticulum not beyond the lateral vertebral body; 2, diverticulum beyond the lateral vertebral body; 3, periradicular contrast; 4, epidural contrast medium collection. Two scores at each level (left, right) were added for a total score. Results were correlated with post-procedure follow-up.ResultsPDPH occurred in 22 (2.8 %) lumbar and 15 (3.7 %) cervical patients. Iodine concentration was not significantly different in lumbar (P = 0.14) or cervical (P = 0.85) patients with or without PDPH. Total scores correlated with PDPH after lumbar (P < 0.0001) and cervical (P < 0.0001) myelography. PDPH patients were younger (P = 0.002 lumbar, P = 0.0001 cervical) and more were female (P = 0.039 lumbar, P = 0.045 cervical). Using multiple regression, a lumbar epidural contrast collection or cervical diverticulum extending beyond the lateral vertebral body correlated with PDPH (P < 0.0001 and P = 0.03, respectively).ConclusionsPDPH correlates with a higher TDL score. Lumbar epidural contrast medium collections and cervical diverticula extending beyond the lateral vertebral body margin are associated with PDPH.Key Points• Elongated cervical nerve root sleeve diverticula are associated with post-dural puncture headaches. • Lumbar epidural contrast medium collections are associated with post-dural puncture headaches. • This information may help assess the risk of post-dural puncture headache.

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