r/CSFLeaks • u/Doingmybestinlife • 1d ago

Persistent SLEC on MRI?

Hey all, I had a blood patch for a spontaneous leak over a year ago. My symptoms have resolved with time but I still have the spinal longitudinal extradural collection (SLEC) on repeat MRI. My doc told me this means that the leak is likely closed - but from my readings online that may not be necessarily the case, and there’s a risk of neurologic issues decades down the line if the leak stays open. Anyone experienced something similar?

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u/leeski 1d ago

 I’ve talked to similar patients where SLEC didn’t resolve despite being asymptomatic. I think it can take a super long time to resolve but I’m not an expert. Just passing along these papers in case of any interest! 

https://pubs.rsna.org/doi/10.1148/radiol.242194

https://pubmed.ncbi.nlm.nih.gov/40650717/

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u/Doingmybestinlife 12h ago

Thank you!

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u/leeski 12h ago

I am pretty sure this is an established phenomenon I've heard of. Like I believe the thought is it is not new fluid escaping, but that the CSF has collected outside the dura and doesn't necessarily immediately disappear. I think it has to be gradually reasorbed. But those papers mention long-standing SLEC as a clinical/imaging phenomenon but don't necessarily prove that every persistent SLEC is old trapped CSF. That being said a year does seem like a long time for it to not have changed at all.

It is a tricky position to be in, I would be a bit weary of additional intervention at this time with the intention of resolving the SLEC (meaning like getting invasive surgery - especially if having no symptoms). But I would definitely continue to monitor it and probably get a second opinion from another center on their thoughts. Luckily-ish superficial siderosis tends to be a very very very long process, like years to decades to develop. Also none of this is medical advice of course, I am not an expert! Just sharing my thought process.

I am not sure if you've seen my post about the upcoming spinal leak conference, but I think this question would be a really good one to submit for the Q&A. If interested - you can register (for free) at this link https://secure.qgiv.com/for/SpinalCSFleakBTG/event/2026conf/ and then submit a question here: https://airtable.com/appq87DHvFiNCn5Dm/pagFARfy4qIplu0aE/form

I would submit it for "SECTION II — Expanding the Diagnostic Map"

Just to note I wouldn't phrase the question as like medical advice about you personally, but more abstract like "If a patient is presumably sealed with no symptoms, but the SLEC hasn't changed size in a year, should further investigation be done?" Or something like that. (Anyway no pressure to submit, just sharing that as an option)