Cisternogram

GENERAL INFORMATION:

What is it? A cisternogram is a test to look for problems with how your cerebral spinal fluid (CSF) circulates (moves). CSF is the fluid that flows through the subarachnoid (SUB-ah-RAK-noid) space that surrounds your brain and spinal cord. This test is a nuclear (NOO-kle-er) medicine scan. Other names for this test include CSF flow scan, intrathecal (IN-trah-THE-kal) scan, and RHISA scan.

Why do I need a cisternogram? A cisternogram may be done to look for problems with CSF flow. It may also be done if you have any of the following medical conditions:

• Blockage in the CSF pathway.
  
  
• CSF leak.
  
  
• CSF shunt problems, such as a blocked shunt.
  
  
• Hydrocephalus (hi-dro-SEF-uh-lus), or normal pressure hydrocephalus (NPH). This is a condition where there are abnormal amounts of CSF around the brain.
  
  
• Tears of the dura (the outermost layer of tissue covering the brain) after an accident, or because of a tumor.

Who should not have this test? Tell your caregiver before the test if you might be or are pregnant. Caregivers may suggest waiting to have the test until after your baby is born. Tell caregivers if you are breast feeding. They may suggest waiting to have the test until after you have finished breast feeding your baby. This should be done to prevent your baby from getting any of the radioactive tracer.

What should I do to get ready for the cisternogram? You do not have to do anything to prepare for the scan. You may eat, drink fluids, and take any medicines that you take regularly.

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

How is a cisternogram performed?

• You will need to remove jewelry and other metal objects, and put on a hospital gown. A caregiver will then do a lumbar puncture (spinal tap). This is done by inserting a needle between the bones in your lower back into the subarachnoid space. A substance called a radioactive tracer is put into the subarachnoid space. The tracer travels with the flow of the CSF.
  
  
• A scan is taken two to six hours later, as you lie flat on a special bed. The bed is moved under the arm of the scanner that can locate the radiation coming off the tracer. Many pictures are taken during the scan to show how the tracer flows with the CSF. You will be scanned several times. Scans are usually done at 24 hours, 48 hours, and even 72 hours after the tracer is given. Each scan takes about 60 minutes (one hour).

What will I feel during the scan? Medicine will be given to numb (make you lose feeling in) the area of the lumbar puncture. You may still feel pressure in the area as the lumbar puncture is being done. The scan itself is painless, but you may be uncomfortable lying still on the hard table during the scan. Caregivers may offer you medicine to help you lie still.

What should I do after the scan? Your caregiver may have you lie flat after the lumbar puncture. Lying flat may help prevent you from getting a headache after the scan. You may continue activities, eat, drink, and take your usual medicines as you did before the test. Drink plenty of fluids, such as water and juices to help flush the tracer out of your body. The tracer leaves your body quickly through your urine. Your caregiver may tell you to flush the toilet three times after going to the bathroom. This makes sure that the small amount of tracer that leaves your body does not stay in the toilet bowl.

Risks

• The place where your lumbar puncture was performed could become red, swollen, painful, or infected. Sometimes a lumbar puncture causes a headache, meningitis (men-in-JI-tis), which is bleeding into the spinal canal, or herniation of brain tissue. Rarely, a person might get a rash, swelling, or a serious allergic reaction to the tracer. The radiation that is in the tracer solution is small and safe. The camera used for the scan does not take x-rays.
  
  
• If you do not have a cisternogram, caregivers may not be able to decide what would be the best care for your health problems. Your problem could get worse or you could die. Call your caregiver if you are worried or have questions about your medicine or care.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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