Nuclear Medicine & Radiation Therapy

Christmas Tree Sign: Paraspinal Cerebrospinal Leak on 99mtc-DTPA Radionuclide Cisternography

Abstract

Nosheen Fatima, Maseeh uz Zaman, Atta ul Aleem Bhatti, Imtiazul Haque Khurshaidi, Ali Jawaid Siddiqui and Aitadal Moin Shaikh

Radionuclide cisternography (RC) is an underutilized but sensitive modality used to differentiate between normal pressure and non-communicating hydrocephalus and can also detect cerebrospinal fluid (CSF) leakage. We present a case of intracranial tuberculous with severe headache and hydrocephalus. RC was performed with Tc-99m labeled DTPA showing communicating hydrocephalus with characteristics Christmas tree sign and early appearance of renal activity due to spinal CSF leak into systemic circulation. This patient responded well to ventriculo-peritoneal shunt (VP shunt).