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Akiba C, Bandai H, Ito Y, Maeda T, Yamaguchi K, Nakajima M, Miyajima M. Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report. BMC Neurol 2020; 20:151. [PMID: 32326909 PMCID: PMC7181568 DOI: 10.1186/s12883-020-01697-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. CASE PRESENTATION A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3-4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively. CONCLUSION The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension.
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Affiliation(s)
- Chihiro Akiba
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
| | - Hideki Bandai
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Yoshitaka Ito
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Tsuyoshi Maeda
- Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075 Japan, Japan
| | - Keisuke Yamaguchi
- Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075 Japan, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
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Chan SM, Chodakiewitz YG, Maya MM, Schievink WI, Moser FG. Intracranial Hypotension and Cerebrospinal Fluid Leak. Neuroimaging Clin N Am 2019; 29:213-226. [DOI: 10.1016/j.nic.2019.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Concescu D, Moldovanu I, Odobescu S, Mawet J, Ruseva A, Vovc V, Roos C. [Post-lumbar puncture syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:87-92. [PMID: 30585611 DOI: 10.17116/jnevro201811811187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article presents a clinical case which describes some clinical aspects, risk factors, management and the prophylactic methods to prevent the post-lumbar puncture syndrome.
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Affiliation(s)
- D Concescu
- Emergency Headache Center, Lariboisiere Hospital, AP-HP, F-75010, Paris, France; Institute of Neurology and Neurosurgery, Kischinev, the Republic of Moldova
| | - I Moldovanu
- Institute of Neurology and Neurosurgery, Kischinev, the Republic of Moldova; Nicolae Testemitsanu University of Medicine and Pharmacy, Kishinev, the Republic of Moldova
| | - S Odobescu
- Institute of Neurology and Neurosurgery, Kischinev, the Republic of Moldova
| | - J Mawet
- Emergency Headache Center, Lariboisiere Hospital, AP-HP, F-75010, Paris, France
| | - A Ruseva
- Institute of Neurology and Neurosurgery, Kischinev, the Republic of Moldova
| | - V Vovc
- Nicolae Testemitsanu University of Medicine and Pharmacy, Kishinev, the Republic of Moldova
| | - C Roos
- Emergency Headache Center, Lariboisiere Hospital, AP-HP, F-75010, Paris, France
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Karabakan G, Özgür A, Okuyaz Ç, Yıldırım HU, Atıcı ŞR. Improved spinal MRI findings after epidural blood patch administration: A pediatric case. EGYPTIAN JOURNAL OF ANAESTHESIA 2018. [DOI: 10.1016/j.egja.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Güldane Karabakan
- Mersin University, Faculty of Medicine, Department of Algology, Mersin, Turkey
| | - Anıl Özgür
- Mersin University, Faculty of Medicine, Department of Radiology, Mersin, Turkey
| | - Çetin Okuyaz
- Mersin University, Faculty of Medicine, Department of Pediatric Neurology, Mersin, Turkey
| | | | - Şebnem Rumeli Atıcı
- Mersin University, Faculty of Medicine, Department of Algology, Mersin, Turkey
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Fain O, Mekinian A. Les pachyméningites. Rev Med Interne 2017; 38:585-591. [DOI: 10.1016/j.revmed.2017.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/10/2017] [Indexed: 01/29/2023]
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Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma. Case Rep Anesthesiol 2016; 2016:5789504. [PMID: 27651956 PMCID: PMC5019880 DOI: 10.1155/2016/5789504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022] Open
Abstract
Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.
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Le syndrome post-ponction lombaire. Revue de la littérature et expérience des urgences céphalées. Rev Neurol (Paris) 2014; 170:407-15. [DOI: 10.1016/j.neurol.2014.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/18/2013] [Accepted: 02/11/2014] [Indexed: 11/21/2022]
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Burns J, Scheinfeld MH. Back to the scanner: expected and unexpected imaging findings following spinal puncture and access. Emerg Radiol 2013; 20:291-7. [DOI: 10.1007/s10140-013-1111-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/12/2013] [Indexed: 11/25/2022]
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Waidelich JM, Bullough AS, Mhyre JM. Internal carotid artery dissection: an unusual cause of postpartum headache. Int J Obstet Anesth 2008; 17:61-5. [PMID: 17693076 DOI: 10.1016/j.ijoa.2007.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 04/01/2007] [Indexed: 11/18/2022]
Abstract
We report a case of postpartum headache caused by internal carotid artery dissection in a 36-year-old woman following uneventful epidural analgesia for spontaneous labor and vaginal delivery. Cervicocerebral arterial dissection requires rapid diagnosis and anticoagulation to prevent thrombus formation and to avoid secondary cerebral thromboembolism. Fortunately, our patient suffered ischemic symptoms, but no permanent neurologic deficit. Anesthesiologists should consider carotid artery dissection in the differential diagnosis of postpartum headache.
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Affiliation(s)
- J M Waidelich
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109-0048, USA
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Raffin L, Batiste C, Noël D, Serbouh A. Blood patch, il n'est jamais trop tard. ACTA ACUST UNITED AC 2006; 25:201-5. [PMID: 16310337 DOI: 10.1016/j.annfar.2005.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Accepted: 08/07/2005] [Indexed: 10/25/2022]
Abstract
Long lasting postural puncture headache secondary to an unintentional dural puncture (UDP) during epidural anaesthesia (EA) or following deliberate dural puncture for spinal anaesthesia, and neurological or neuroradiological examination, is becoming unusual. Placing the bevel of Tuohy needle parallel to the longitudinal axis of the dural cylinder when searching for epidural space, and in the later cases, widespread use of small diameter, atraumatic needles, have decreased both its incidence and severity. Furthermore, in the absence of any contraindication, patients suffering from such troubles are now quite systematically offered a curative epidural blood patch (EBP) whose effectiveness is documented. Authors report an original case of a fainthearted patient who underwent caesarean section under EA when she was 31-year-old, and whose disabling painful symptoms related to a UDP were successfully relieved by one EBP that she ended to accept more than seven years later. On the occasion of a short literature review, physiopathology and management are debated.
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Affiliation(s)
- L Raffin
- Clinique Les Martinets, 97, avenue Albert-1(er), 92500 Rueil-Malmaison, France.
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Rice I, Mountfield J, Radhakrishnan D, Nelson-Piercy C. Puerperal seizures associated with post dural puncture headache. Int J Obstet Anesth 2003; 12:126-9. [PMID: 15321502 DOI: 10.1016/s0959-289x(03)00012-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We present a case of tonic-clonic seizure occurring on day four post partum and associated with severe post dural puncture headache. The possible underlying aetiologies of this and two other cases we have managed and the difficulty distinguishing such seizures from eclampsia are discussed.
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Affiliation(s)
- I Rice
- Department of Obstetric Anaesthesia, Princess Anne Hospital, Southampton, UK
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12
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Abstract
Postdural puncture headache (PDPH; or "spinal headache) is the most common significant complication from regional anesthesia or analgesia in obstetrics. Recent advances in spinal needle design have dramatically decreased the incidence of headache after spinal anesthesia, and now the most common cause of PDPH is inadvertent puncture of the dura with an epidural needle. The diagnosis and treatment of a PDPH should usually be the responsibility of the anesthesiologist, but it is important for the obstetrician to be familiar with the clinical course and options for therapy, and the usual treatment strategies. This article discusses the differential diagnosis of postdelivery headache, the current understanding of the pathophysiology of PDPH, options for medical treatment, and the controversial issue of whether and when to treat the headache with an epidural blood patch.
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Affiliation(s)
- Pamela Flood
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Fain O, Seror O, Wirth JF, Heron C, Mathieu E, Chamouard JM, Guillevin L, Thomas M. [Cranial pachymeningitis]. Rev Med Interne 1999; 20:234-46. [PMID: 10216880 DOI: 10.1016/s0248-8663(99)83051-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pachymeningitis is a fibrous inflammatory process with non-specific symptoms, involving the dura mater. Due to MRI development, diagnosis is both easier and earlier. CURRENT KNOWLEDGE AND KEY POINTS We report seven cases and review current literature. Clinical features are headaches and cranial nerve palsies. CSF shows inflammatory changes, while MRI evidences thickening of the dura mater. Disease etiologies in the present study were tuberculosis in two cases, sarcoidosis, Lyme disease, lymphoma and dural puncture; in one case only the disease was of unknown origin. The condition of six patients improved with specific treatment. FUTURE PROSPECTS AND PROJECTS Further MRI development should allow detection of new forms of pachymeningitis and standardization of patients' management through the study of more important series.
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Affiliation(s)
- O Fain
- Service de médecine interne, hôpital Jean-Verdier, Bondy, France
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