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 Indian J Med Microbiol  
 

Figure 4 (A-L): Sagittal T2 W (A,B) and axial T2W (C) spine MRIs show the ventral extra-arachnoid fluid collection (thin white arrows) extending from C2 down to L3 level. The thecal sac and cervical cord is displaced posteriorly by this fluid collection (thick white arrow).MR myelogram (D) also demonstrates the ventral fluid collection (thick white arrows). Sagittal immediate dynamic CT myelogram (E) shows opacification of the ventral fluid collection, with similar density of contrast in ventral fluid collection and the thecal sac at C3-C4 and C4-C5 disc levels (white arrows). Axial immediate dynamic CT myelogram at C4-C5 (F) disc level shows contrast density in the thecal sac and the ventral fluid collection to be similar (thick black arrows), suggesting site of leak. Axial immediate dynamic CT myelogram at C6-C7 (G) disc level shows differential opacification of the ventral fluid collection and the thecal sac (thick white arrows). In addition, pseudomeningocoeles were identified on the left at multiple levels, more prominent at C6-C7 (G) and C7-T1 (H) levels (notched arrows). The nerve root sleeves on the right appear to be separated from the collection, with the differential contrast opacity within the right-sided nerve root sleeves (arrowheads); however, the left-sided nerve root sleeves (thick white arrow) appear to be incorporated within the ventral fluid collection. Also, note the effacement of the CSF space surrounding the cord due to extrinsic compression by the ventral fluid collection (G and H). The epicenter of the compression (C6-C7) is lower than the site of leak (C4-C5). Sagittal oblique reconstructions (I) of early dynamic CT myelogram shows pseudomeningocoles at multiple levels (white arrows) on the left in the cervical spine. Sagittal delayed dynamic CT myelogram (J) shows inferior extension of the ventral fluid collection into the thoracic region (white arrows). Axial immediate (K) and axial delayed (L) images from dynamic CT myelogram of the thoracic spine show progressive equilibration of contrast in the ventral fluid collection in the thoracic region on the delayed scans (L) (thick black arrows)

Figure 4 (A-L): Sagittal T2 W (A,B) and axial T2W (C) spine MRIs show the ventral extra-arachnoid fluid collection (thin white arrows) extending from C2 down to L3 level. The thecal sac and cervical cord is displaced posteriorly by this fluid collection (thick white arrow).MR myelogram (D) also demonstrates the ventral fluid collection (thick white arrows). Sagittal immediate dynamic CT myelogram (E) shows opacification of the ventral fluid collection, with similar density of contrast in ventral fluid collection and the thecal sac at C3-C4 and C4-C5 disc levels (white arrows). Axial immediate dynamic CT myelogram at C4-C5 (F) disc level shows contrast density in the thecal sac and the ventral fluid collection to be similar (thick black arrows), suggesting site of leak. Axial immediate dynamic CT myelogram at C6-C7 (G) disc level shows differential opacification of the ventral fluid collection and the thecal sac (thick white arrows). In addition, pseudomeningocoeles were identified on the left at multiple levels, more prominent at C6-C7 (G) and C7-T1 (H) levels (notched arrows). The nerve root sleeves on the right appear to be separated from the collection, with the differential contrast opacity within the right-sided nerve root sleeves (arrowheads); however, the left-sided nerve root sleeves (thick white arrow) appear to be incorporated within the ventral fluid collection. Also, note the effacement of the CSF space surrounding the cord due to extrinsic compression by the ventral fluid collection (G and H). The epicenter of the compression (C6-C7) is lower than the site of leak (C4-C5). Sagittal oblique reconstructions (I) of early dynamic CT myelogram shows pseudomeningocoles at multiple levels (white arrows) on the left in the cervical spine. Sagittal delayed dynamic CT myelogram (J) shows inferior extension of the ventral fluid collection into the thoracic region (white arrows). Axial immediate (K) and axial delayed (L) images from dynamic CT myelogram of the thoracic spine show progressive equilibration of contrast in the ventral fluid collection in the thoracic region on the delayed scans (L) (thick black arrows)