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Following an accidental dural puncture during the placement of epidural anesthesia, leakage of cerebrospinal fluid occurs. This leads to tugging on intracranial pain-sensitive structures and causes a headache that is postural in nature. According to radiology literature, the presence of retro spinal fluid collections has been associated with the diagnosis of spontaneous intracranial hypotension. The characteristic C1-C2 radiographic sign, called the C1-C2 false localizing sign, can be found on magnetic resonance (MR) images as a focal area of fluid-like signal intensity and on CT myelograms as a CSF collection between the spinous processes of C1 and C2. As our case report demonstrates, this sign is also associated with intracranial hypotension after lumbar puncture.

Persistent Epidural Fluid at the Cervical Spine Level, Lessons from Radiology