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Cirillo L, Verna F, Princiotta C, Dall’Olio M, Rustici A, Bortolotti C, Badaloni F, Mascarella D, Cortelli P, Cevoli S. Spontaneous Intracranial Hypotension and Subdural Hematomas Treatment Management Using MMA Embolization and Target Blood Patch: A Case Report. Life (Basel) 2024; 14:250. [PMID: 38398759 PMCID: PMC10890540 DOI: 10.3390/life14020250] [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: 01/02/2024] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
We report a patient suffering from spontaneous intracranial hypotension (SIH) who, following a non-selective lumbar blood patch, returned to his healthcare provider with severe symptoms of neurological deficits. It was subsequently discovered that the aforementioned deficits were due to a bilateral subdural hematoma, and an emergency surgical drainage of the hematoma has been performed. However, the hematoma reformed and potential cerebrospinal fluid leakage was consequently investigated through myelography. Following the diagnostic finding of a venous diverticulum, a selective blood patch was executed in the affected area, and in order to stabilize the hematoma, an embolization of the middle meningeal arteries was performed. The combination of such operations allowed for the resorption of the hematoma and the improvement of neurological symptoms.
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Affiliation(s)
- Luigi Cirillo
- UO Neuroradiologia, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (L.C.); (C.P.); (M.D.)
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | - Francesca Verna
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | - Ciro Princiotta
- UO Neuroradiologia, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (L.C.); (C.P.); (M.D.)
| | - Massimo Dall’Olio
- UO Neuroradiologia, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (L.C.); (C.P.); (M.D.)
| | - Arianna Rustici
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | - Carlo Bortolotti
- UO Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (C.B.); (F.B.)
| | - Filippo Badaloni
- UO Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (C.B.); (F.B.)
| | - Davide Mascarella
- UO Clinica Neurologica Metropolitana (NEURO-MET), IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (D.M.); (P.C.); (S.C.)
| | - Pietro Cortelli
- UO Clinica Neurologica Metropolitana (NEURO-MET), IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (D.M.); (P.C.); (S.C.)
| | - Sabina Cevoli
- UO Clinica Neurologica Metropolitana (NEURO-MET), IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (D.M.); (P.C.); (S.C.)
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The Relationship Between the Myovertebral Structures and Idiopathic Cerebrospinal Fluid Leaks in Whiplash Injuries. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ohtonari T, Noguchi S, Nishihara N. Acute-Phase Intraoperative Findings of Traumatic Spinal Cerebrospinal Fluid Leakage. World Neurosurg 2021; 148:90-92. [PMID: 33476775 DOI: 10.1016/j.wneu.2021.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
The acute-stage intraoperative findings of the spinal dural laceration in patients with traumatic cerebrospinal fluid (CSF) leakage have not been clearly revealed so far. Herein, we report an interesting case of traumatic CSF leakage in a patient who underwent acute-stage direct closure for a dural laceration similar to a stab at the C1/2 level. Because a 41-year-old man strongly twisted his neck, he had a typical orthostatic headache. Whole-spine T2 fat-saturated magnetic resonance imaging and computed tomographic myelography were examined, and fluid collection between the intrathecal site and epidural dorsal space, including soft tissue, was confirmed as a direct CSF leakage at the C1/2 level. Direct surgical closure was performed 13 days after the onset of symptoms, and dural laceration with sharp edges was detected on the right side at the C1/2 level. The laceration was sutured and coated with dural sealant. Finally, the patient's orthostatic headache was relieved completely after the operation.
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Affiliation(s)
- Tatsuya Ohtonari
- Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
| | - Shohei Noguchi
- Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan; Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Nobuharu Nishihara
- Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
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