What is a cisternogram scan?

A cisternogram scan is a test that measures the flow of cerebrospinal fluid around your brain and spine. This protective fluid:

• Brings nutrients to your brain and spine.
• Aids your central nervous system functions.
• Removes toxins from your CNS tissues.
• Acts as a shock-absorbing cushion to help cushion your brain in case of concussion.

It is a kind of nuclear medicine scan. That's why doctors also call this scan the radionuclide cisternogram. In this test, you are given a spinal injection of a radioactive agent. Radioactive agents help some body components or activities to appear more evident on scanning tests. Your provider can visualize how the fluid surrounding your brain and spinal cord moves.

When does someone need a cisternogram?

Your doctor may refer you to a cisternogram if they suspect that you have a CSF leak or a buildup of CSF. Symptoms of either include:

• Balance problems.
• Dizziness.
• Headaches.
• Hearing loss.
• Nausea and vomiting.
• Neck pain.
• Sensitivity to light or sound.
• Trouble thinking clearly or concentrating.

How do I prepare for cisternogram scan?

Most people do not have to do any special preparation before having a cisternogram. Your provider may advise you to avoid eating and drinking for a period of time before your test. Make sure that you have someone to take you home after your procedure is completed.

Tell your health care provider if you:

• Have allergies to local anesthetic (numbing medicine) or anesthesia.
• May be pregnant.
• Drugs you take, such as vitamins and supplements. Some drugs increase the risk of bleeding, so your doctor may advise you to stop these medications for a period before the test.

What happen during a cisternogram?

A cisternogram starts with a spinal tap (lumbar puncture):

You receive an injection of a local anesthetic that numbs your spine. Other people also need a sedative to relax or, rarely, general anesthesia.

Lie down on a table with your face down, or sit up and lie down sideways with your knees pulled up toward your chest.

Your doctor will insert a thin, hollow needle into your spine. Fluoroscopy guides the needle between your vertebrae and into the space surrounding your spinal cord.

The radioactive material will be injected into your CSF with the help of the needle tip.

Your doctor will withdraw the needle.

Once you get the lumbar puncture done, you remain very still for nearly an hour because the radioactive stuff moves around in your CSF. Around one to six hours after the lumbar puncture, your healthcare provider takes images of your spine through imaging scans. He'll use a special camera to spot the radioactive material. A CT scan or an MRI creates the images.

After the imaging scan, you may be allowed to go home, but you will need to return for another scan 24 hours later. The radioactive material cannot reach all the cavities in your brain throughout the day. Additionally, some patients need to have scans 48 and 72 hours after surgery. You do not need more lumbar punctures before each imaging scan.

Does a cisternogram scan hurt?

You may feel some burning or discomfort from the anesthetic injection. As your physician advances the needle into your spine, you may be aware of pressure but should not have pain. The imaging tests are painless.

Does a cisternogram cause side effects?

The most common side effects post-cisternogram are pain at the injection site and headache. Spinal headaches can occur as a consequence of leakage of CSF fluid from the injection site following a lumbar puncture. This temporary leakage causes the pressure inside your brain to drop, thereby causing severe headache. It is usually self-limiting, resolving on its own in a matter of a few hours or days.

Is there a danger in having a cisternogram?

Complications following a cisternogram are rare, but might include:

• Allergic reaction to the radioactive material or anesthesia.
• Brainstem herniation (pressure within the skull moves brain tissue).
• Bleeding within the brain or spine.
• Infection.
• Damage to nerves.

There is certainly some radiation exposure from the cisternogram; however, the amount is very low.

When should I expect to know the outcome of my cisternogram scan?

You may need to wait several days or even a week after your last scan before the results come back. Ask your physician what you should expect.

What do cisternogram results mean?

When your cisternogram is normal, it means that CSF flows around your brain and spinal cord normally. There are no leaks or blockages.

Abnormal results might indicate:

• Leakage of CSF, very often as a result of head injury, skull fracture or dural tear. In addition, some types of surgery or other medical interventions can cause CSF leaks.
• Problems with the shunt, in the brain, where the shunt is no longer working properly. Shunts are the most common solution to hydrocephalus.
• Hydrocephalus, which is pressure in the head due to accumulation of CSF.
• Normal-pressure hydrocephalus (NPH), in which CSF is gathered without increased pressure on the brain.
• Pseudotumor cerebri, or "false brain tumor," which is pressure in the head for which no cause can be found. It also is known as idiopathic intracranial hypertension.

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