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Šimonová J, Jaselská S, Šimon R, Janková Šimonová M. A Low-Volume Epidural Blood Patch for the Treatment of Spontaneous Intracranial Hypotension: A Case Report. Cureus 2024; 16:e63059. [PMID: 38915836 PMCID: PMC11196121 DOI: 10.7759/cureus.63059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 06/26/2024] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a rare neurological syndrome. We report the case of a 47-year-old woman with acute, severe orthostatic headache after surgery, chemotherapy, and radiotherapy for breast cancer. The brain and spine magnetic resonance imaging showed signs of intracranial hypotension. We describe the results of a non-targeted epidural blood patch with 10 mL of the patient's blood administered after unsuccessful conservative treatment. After the procedure, the patient reported gradual headache relief. This effect persisted over one year. The case shows that a single non-targeted low-volume epidural blood patch can be an effective treatment option for a patient with SIH when conservative treatment fails.
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Affiliation(s)
- Jana Šimonová
- 1st Department of Anaesthesiology and Intensive Medicine, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, SVK
- 1st Department of Anaesthesiology and Intensive Medicine, Louis Pasteur University Hospital, Košice, SVK
| | | | - Róbert Šimon
- 1st Department of Surgery, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, SVK
- 1st Department of Surgery, Louis Pasteur University Hospital, Košice, SVK
| | - Michaela Janková Šimonová
- Department of Neurosurgery, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, SVK
- Department of Neurosurgery, Louis Pasteur University Hospital, Košice, SVK
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2
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Jurcau MC, Jurcau A, Hogea VO, Diaconu RG. Spontaneous Intracranial Hypotension: Case Report and Update on Diagnosis and Treatment. Diagnostics (Basel) 2024; 14:881. [PMID: 38732297 PMCID: PMC11083259 DOI: 10.3390/diagnostics14090881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Spontaneous intracranial hypotension (SIH) is an important cause of daily headaches that occur in young and middle-aged, active persons and is often misdiagnosed, leading to prolonged inactivity and rather high healthcare expenditures. Its diagnosis requires a high degree of clinical suspicion and careful interpretation of imaging studies. We present a case of SIH, which was successfully treated but which posed serious diagnostic challenges, ranging from cerebro-vascular disease and meningitis to granulomatous diseases, and for whom every therapeutic attempt just worsened the patient's condition until we finally reached the correct diagnosis. To raise awareness of this condition, we also present an updated overview of the clinical picture, evaluation, and treatment options for SIH.
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Affiliation(s)
- Maria Carolina Jurcau
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.C.J.); (V.O.H.); (R.G.D.)
| | - Anamaria Jurcau
- Department of Psycho-Neurosciences and Rehabilitation, University of Oradea, 410087 Oradea, Romania
| | - Vlad Octavian Hogea
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.C.J.); (V.O.H.); (R.G.D.)
| | - Razvan Gabriel Diaconu
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (M.C.J.); (V.O.H.); (R.G.D.)
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García-Ull J, González-García N, Torres-Ferrús M, García-Azorín D, Molina-Martínez IFJ, Beltrán-Blasco I, Santos-Lasaosa S, Latorre G, Gago-Veiga AB, Láinez JM, Porta-Etessam J, Nieves-Castellanos C, Mínguez-Olaondo A, López-Bravo A, Quintas S, Morollón N, Díaz-Insa S, Belvís R, Irimia P. Diagnosis and treatment of disorders of intracranial pressure: consensus statement of the Spanish Society of Neurology's Headache Study Group. Neurologia 2024:S2173-5808(24)00048-8. [PMID: 38431253 DOI: 10.1016/j.nrleng.2024.02.009] [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: 03/05/2024] Open
Abstract
Primary intracranial pressure disorders include idiopathic intracranial hypertension and spontaneous intracranial hypotension. Remarkable advances have been made in the diagnosis and treatment of these 2entities in recent years. Therefore, the Spanish Society of Neurology's Headache Study Group (GECSEN) deemed it necessary to prepare this consensus statement, including diagnostic and therapeutic algorithms to facilitate and improve the management of these disorders in clinical practice. This document was created by a committee of experts belonging to GECSEN, and is based on a systematic review of the literature, incorporating the experience of the participants, and establishes practical recommendations with levels of evidence and grades of recommendation.
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Affiliation(s)
- J García-Ull
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain.
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - M Torres-Ferrús
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Spain
| | - I F J Molina-Martínez
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - I Beltrán-Blasco
- Unidad de Cefaleas, Servicio de Neurología, Hospital General Universitario Dr. Balmis de Alicante, Spain
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - A B Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - J M Láinez
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - C Nieves-Castellanos
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario y Politécnico la Fe, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - A Mínguez-Olaondo
- Servicio de Neurología, Hospital Universitario Donostia, Instituto de Investigación Biodonostia, Athenea Neuroclinicis, Donostia, Facultad de Ciencias de la Salud, Universidad de Deusto, Bilbao, Spain
| | - A López-Bravo
- Servicio de Neurología, Hospital Reina Sofía de Tudela, Navarra, Spain
| | - S Quintas
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - N Morollón
- Unidas de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario y Politécnico la Fe, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - R Belvís
- Unidas de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Irimia
- Unidad de Cefaleas, Servicio de Neurología, Clínica Universitaria de Navarra, Pamplona, Spain
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Williams J, Brinjikji W, Cutsforth-Gregory JK. Natural history of spontaneous intracranial hypotension: a clinical and imaging study. J Neurointerv Surg 2023; 15:1124-1128. [PMID: 36357170 DOI: 10.1136/jnis-2022-019300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although spontaneous intracranial hypotension (SIH) is well studied, there are few studies of the clinical and imaging history of SIH without interventional treatments. For example, what is the natural history of those who are untreated or treated only with conservative measures? OBJECTIVE To conduct a retrospective study examining changes in imaging findings for patients with SIH without interventional treatments and to study associations between imaging findings and clinical symptoms. METHODS Included patients had a clinical diagnosis of SIH, were seen at Mayo Clinic between 1999 and 2021, had a brain MRI scan indicating SIH (Bern score), and had a brain MRI scan 6 or more months later without intervening leak-related interventional treatment. Bern scores were assigned for the first and last MRI scans prior to treatment. Patients were also grouped into three qualitative categories: overall improvement of symptoms, stable symptoms, or worsened symptoms based on patient report during the clinical visit at the time of the follow-up brain MRI scan. RESULTS Among 46 patients with untreated SIH, the Bern score improved over time in 11 (24%), was stable in 30 (65%), and worsened in 5 (11%). Two patients (4.3%) showed complete resolution of all abnormalities by the Bern scoring criteria. Symptoms improved in 7 (15%), were stable in 29 (63%), and worsened in 10 (22%). CONCLUSIONS In patients with brain MRI evidence of SIH, almost 25% demonstrated radiographic improvement, and 15% reported clinical improvement, during at least 6 months of observation or conservative treatment. Most had stable, persistent MRI abnormalities and symptoms when SIH was untreated.
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Affiliation(s)
- James Williams
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Radiology & Neurological Surgery, Mayo Clinic, Rochester, MN, USA
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Utukuri PS, Shih RY, Ajam AA, Callahan KE, Chen D, Dunkle JW, Hunt CH, Ivanidze J, Ledbetter LN, Lee RK, Malu O, Pannell JS, Pollock JM, Potrebic SX, Setzen M, Shih RD, Soares BP, Staudt MD, Wang LL, Burns J. ACR Appropriateness Criteria® Headache: 2022 Update. J Am Coll Radiol 2023; 20:S70-S93. [PMID: 37236753 DOI: 10.1016/j.jacr.2023.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Headache is an ancient problem plaguing a large proportion of the population. At present, headache disorders rank third among the global causes of disability, accounting for over $78 billion per year in direct and indirect costs in the United States. Given the prevalence of headache and the wide range of possible etiologies, the goal of this document is to help clarify the most appropriate initial imaging guidelines for headache for eight clinical scenarios/variants, which range from acute onset, life-threatening etiologies to chronic benign scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Robert Y Shih
- Panel Chair, Uniformed Services University, Bethesda, Maryland
| | | | - Kathryn E Callahan
- Wake Forest School of Medicine, Winston Salem, North Carolina; American Geriatrics Society
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | - Jeffrey W Dunkle
- Indiana University School of Medicine, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Omojo Malu
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia; American Academy of Family Physicians
| | | | | | - Sonja X Potrebic
- Southern California Permanente Medical Group, Pasadena, California; American Academy of Neurology
| | - Michael Setzen
- Weill Cornell Medical College, New York, New York; American Academy of Otolaryngology-Head and Neck Surgery
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - Bruno P Soares
- The University of Vermont Medical Center, Burlington, Vermont
| | - Michael D Staudt
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Jolly K, Gupta KK, Bhamra N, Aslanidou A, Batra R, Ahmed SK. Endonasal endoscopic management of spontaneous cerebrospinal fluid rhinorrhoea: The Birmingham UK experience. Asian J Endosc Surg 2023; 16:68-76. [PMID: 36116916 DOI: 10.1111/ases.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Spontaneous cerebrospinal fluid (CSF) leaks (SCSFL) occur in the absence of trauma, surgery, or underlying intracranial pathology. They represent a significant healthcare burden on patients with complications such as meningitis. We present our experience of SCSFL repair via the endonasal endoscopic approach. METHODS All patients who underwent CSF fistula repair at a tertiary UK hospital, between 1st January 2012 to 31st December 2019, were identified and had their case notes analyzed retrospectively. RESULTS There were 33 patients included consisting of 27 (81.8%) females, with age range from 31 to 81 years (mean 55.2). Mean body mass index (BMI) was 35.2 kg/m2 , with 32 (97.0%) patients overweight (BMI >25). All patients presented with intermittent watery rhinorrhoea and had a positive biochemical analysis. Computed tomography (CT) and/or magnetic resonance imaging (MRI) identified leak sites in 29 patients (87.9%). The most common intraoperative defect site was the cribriform plate (42.4%). A variety of closing techniques were used including onlay grafts (72.7%), tissue glue (87.9%), nasoseptal flaps (63.6%), mucosal free grafts (21.2%), fat grafts (21.2%), and additional support materials (87.9%). Nasal packing was used in all patients. The average length of stay was 1.6 days. Postoperative complications occurred in two patients (6.1%) (meningitis, epistaxis). Overall, there was a successful primary repair in 32 (97.0%) patients with most cases employing a multilayered reconstruction method (78.8%). CONCLUSION Our results demonstrate excellent success rates with the endoscopic endonasal approach to SCSFL. This adds to the literature by demonstrating a detailed analysis of the experience in SCSFL management in one of the largest UK centres.
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Affiliation(s)
- Karan Jolly
- Department of Otolaryngology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Keshav Kumar Gupta
- Department of Otolaryngology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Navdeep Bhamra
- Department of Otolaryngology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anastasia Aslanidou
- Department of Otolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ruchika Batra
- Department of Otolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shahzada K Ahmed
- Department of Otolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Leung LWL, Chan YCD, Chan TMD. Lumbar epidural blood patch: An effective treatment for intracranial hypotension. Surg Neurol Int 2022; 13:517. [DOI: 10.25259/sni_795_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background:
The literature has demonstrated the efficacy of lumbar epidural blood patch (LEBP) in the management of spontaneous intracranial hypotension (SIH). However, the underlying pathophysiology of such management remains unclear. In this study, we aim to evaluate the utility of LEBP injections in the management of SIH and develop a potential management algorithm used in the triage and management of SIH patients.
Methods:
We retrospectively examined the clinical case notes of 14 patients with SIH (age: 25–69 years) who were managed with LEBP injections during the year of 2016–2021. We evaluated the presenting symptoms of each selected patient and radiological findings as well as treatment outcomes. Our aim is to evaluate the effectiveness of LEBP in the treatment of SIH patients through follow-up clinical and imaging assessment.
Results:
About 93% of patients describe the presence of headache at presentation, while 43% describe it as being of an orthostatic nature. All patients demonstrated typical findings on magnetic resonance imaging brain. Treatment success assessed through symptomatic improvement and radiological resolution was found in 85% of our patients at a 2-month interval.
Conclusion:
LEBP injection is an effective method of management in patients with a diagnosis of SIH. It should be considered in all SIH patients irrespective of whether a “dural leak” can be localized through radiological investigations.
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Alomari MH, Shahin MM, Fishman SJ, Kerr CL, Smith ER, Eng W, Ruiz-Gutierrez M, Adams DM, Orbach DB, Chaudry G, Shaikh R, Chewning R, Alomari AI. Cerebrospinal fluid leak in epidural venous malformations and blue rubber bleb nevus syndrome. J Neurosurg Spine 2022; 37:439-445. [PMID: 35364593 DOI: 10.3171/2022.1.spine2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Clinical manifestations of blue rubber bleb nevus syndrome (BRBNS) and multifocal venous malformation (MVM) vary depending on the location of the lesions. The aim of this study was to assess the risk of developing CSF leaks in patients with epidural venous malformations (VMs). METHODS The authors retrospectively investigated the relationship between the development of a CSF leak and the presence of epidural VMs. RESULTS Nine patients (5 females) had epidural VMs and presentation that was confirmatory or suggestive of a CSF leak: 4 had BRBNS, 4 had MVMs, and 1 had a solitary VM. Of 66 patients with BRBNS, clinical and imaging features of CSF leak were noted in 3 (4.5%) with epidural VMs at the age of 11-44 years. A fourth patient had suggestive symptoms without imaging confirmation. An epidural blood patch was ineffective in 2 patients, both with more than one source of leakage, requiring surgical repair or decompression. Symptomatic downward displacement of the cerebellar tonsils was noted in 3 patients with MVM and 1 with a solitary VM; 3 required surgical decompression. CONCLUSIONS These findings suggest an increased risk of CSF leak in patients with epidural VM, including BRBNS, MVMs, and solitary VMs. Awareness of the association between epidural VM and CSF leakage may facilitate earlier diagnosis and therapeutic intervention.
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Affiliation(s)
| | | | | | - Cindy L Kerr
- 1Division of Vascular and Interventional Radiology
| | | | - Whitney Eng
- 4Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Melisa Ruiz-Gutierrez
- 4Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Denise M Adams
- 4Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Raja Shaikh
- 1Division of Vascular and Interventional Radiology
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Kewlani B, Garton ALA, Hussain I, Chazen JL, Robbins MS, Baaj AA, Greenfield JP. Intracranial hypotension due to ventral thoracic dural tear secondary to osteophyte complex: resolution after transdural thoracic microdiscectomy with dural repair. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21615. [PMID: 36273860 PMCID: PMC9379770 DOI: 10.3171/case21615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intracranial hypotension (IH) manifests with orthostatic headaches secondary to cerebrospinal fluid (CSF) hypovolemia. Common iatrogenic etiologies include lumbar punctures and spinal surgery. Although much rarer, structural defects such as osteophytes and herniated calcified discs can violate dural integrity, resulting in CSF leak. OBSERVATIONS The authors reported the case of a 32-year-old woman who presented with progressively worsening orthostatic headaches. During an extensive examination, magnetic resonance imaging of her thoracic spine revealed a cervicothoracic ventral epidural collection of CSF, prompting a dynamic computed tomography myelogram, which not only helped to confirm severe cerebral hypotension but also suggested underlying pathology of a dorsally projecting disc osteophyte complex at T2–3. Conservative and medical management failed to alleviate symptoms, and a permanent surgical cure was eventually sought. The patient underwent a transdural thoracic discectomy with dural repair, which resulted in resolution of her symptoms. LESSONS Clear guidelines regarding the management strategy of IH secondary to disc osteophyte complexes are yet to be established. A thorough literature review noted only 24 reported cases between 1998 and 2019, in which 13 patients received surgery. There is a 46% symptom resolution rate with conservative management, lower than that for iatrogenic etiologies. For patients in whom conservative management failed, surgical intervention proved effective in resolving symptoms, with a success rate of 92.3%.
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Affiliation(s)
- Bharti Kewlani
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, NewYork Presbyterian Hospital, New York, New York
- Department of Neurological Surgery, Beaumont Hospital, Dublin, Ireland
| | - Andrew L. A. Garton
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, NewYork Presbyterian Hospital, New York, New York
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, NewYork Presbyterian Hospital, New York, New York
| | - J. Levi Chazen
- Departments of Interventional Radiology and Diagnostic Radiology and
| | - Matthew S. Robbins
- Neurology, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York; and
| | - Ali A. Baaj
- Department of Neurological and Orthopaedic Surgery, University of Arizona—Banner Health System, Phoenix, Arizona
| | - Jeffrey P. Greenfield
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, NewYork Presbyterian Hospital, New York, New York
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10
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Mourozeau L, Haution D, Vautier A, Gohier P. Sixth cranial nerve palsy secondary to spontaneous intracranial hypotension complicated by cerebral sinus venous thrombosis: Case report. J Fr Ophtalmol 2021; 45:e23-e24. [PMID: 34801274 DOI: 10.1016/j.jfo.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Affiliation(s)
- L Mourozeau
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France.
| | - D Haution
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France
| | - A Vautier
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France
| | - P Gohier
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France
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11
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D’Amico D, Usai S, Chiapparini L, Erbetta A, Gioppo A, Messina G, Astengo A, Leone M. Headache in spontaneous intracranial hypotension: an overview with indications for differential diagnosis in the clinical practice. Neurol Sci 2020; 41:423-427. [DOI: 10.1007/s10072-020-04642-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Perez-Vega C, Robles-Lomelin P, Robles-Lomelin I, Diaz-Alba A, Navarro VG. Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension – A non-reported complication. Surg Neurol Int 2020; 11:316. [PMID: 33093993 PMCID: PMC7568103 DOI: 10.25259/sni_385_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/02/2020] [Indexed: 01/15/2023] Open
Abstract
Background:
Spontaneous intracranial hypotension (SIH) is an uncommon, benign, and generally self-limiting condition caused by low cerebrospinal fluid (CSF) volume and pressure usually caused by a CSF leak. Patients with SIH have an increased incidence of subdural hematomas (SDH), which may be bilateral and recurrent.
Case Description:
We report a unique case of a man presenting with SIH and bilateral SDH that were drained with bilateral craniotomies. During drain removal, the patient had an acute neurological deterioration and a CT scan showed SDH recurrence. The patient had two new recurrent SDH afterwards. After the third surgical intervention, the drain was removed in the OR with concomitant subdural saline infusion, there was no recurrence of SDH after that and the patient has had no further complications after a 2-year follow-up.
Conclusion:
Patients with intracranial hypotension are predisposed to form SDH. In this case, drain removal caused further decrease in intracranial pressure and triggered a new SDH formation, subdural saline irrigation masked atmospheric pressure and prevented this complication from happening again.
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Affiliation(s)
- Carlos Perez-Vega
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Zapopan, Jalisco, Mexico,
| | - Pilar Robles-Lomelin
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Zapopan, Jalisco, Mexico,
| | - Isabel Robles-Lomelin
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Zapopan, Jalisco, Mexico,
| | - Alexandra Diaz-Alba
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Zapopan, Jalisco, Mexico,
- Department of Neurology, Instituto Neurologico de Guadalajara S.C., Guadalajara, Jalisco, Mexico
| | - Victor Garcia Navarro
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Zapopan, Jalisco, Mexico,
- Department of Neurology, Instituto Neurologico de Guadalajara S.C., Guadalajara, Jalisco, Mexico
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