1
|
Antonescu-Ghelmez D, Butnariu I, Antonescu F, Maier C, Moraru A, Bucur AI, Anghel DN, Tuţă S. Thunderclap headache revealing dural tears with symptomatic intracranial hypotension: Report of two cases. Front Neurol 2023; 14:1132793. [PMID: 36908611 PMCID: PMC9996024 DOI: 10.3389/fneur.2023.1132793] [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: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Cerebrospinal fluid (CSF) leakage is considered the cause of spontaneous intracranial hypotension (SIH), an important etiology for new daily persistent headaches and a potentially life-threatening condition. Minor traumatic events rarely lead to CSF leakage, contrasting with iatrogenic interventions such as a lumbar puncture or spinal surgery, which are commonly complicated by dural tears. Most meningeal lesions are found in the cervicothoracic region, followed by the thoracic region, and rarely in the lumbar region, and extremely rarely in the sacral region. We describe two patients admitted to our hospital for severe headaches aggravated in the orthostatic position, with a recent history of minor trauma and sustained physical effort, respectively. In the first case, a bone fragment pierced an incidental congenital meningocele creating a dural fistula. An extensive extradural CSF collection, spanning the cervicothoracic region (C4-T10), was described in the second case. In both patients, the clinical evolution was favorable under conservative treatment.
Collapse
Affiliation(s)
- Dana Antonescu-Ghelmez
- Department of Neurology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioana Butnariu
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Florian Antonescu
- Department of Neurology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Maier
- MedInst Romanian-German Diagnostic Center, Bucharest, Romania
| | - Adriana Moraru
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Amanda Ioana Bucur
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniela Nicoleta Anghel
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Sorin Tuţă
- Department of Neurology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
2
|
Rahimizadeh A, Javadi SA. Symptomatic intraspinal lumbosacral pseudomeningocele, a late consequence of root avulsion injury secondary to a gunshot wound. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2020; 3:100025. [PMID: 35141593 PMCID: PMC8820008 DOI: 10.1016/j.xnsj.2020.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 12/03/2022]
Abstract
Background Traumatic pseudomeningocele are usually a late consequence of cervical root avulsion injury and its occurrence in lumbosacral region is rare. This pathology is mostly due to violent blunt traumatic events and usually develops outside of the spinal canal. Occasionally, a pseudomeningocele may grow inside of the spinal canal causing delayed neurological deficit due to compromise of the adjacent neural structures. Case description Evaluation of a delayed left lower extremity weakness in a young man with a history of a gunshot wound injury revealed an extradural pseudomeningocele arising from an S1 root avulsion injury with compressive effect on the adjacent L5 root Outcome Excision of the cyst wall and reinstitution of the nerve root sheath resulted in an uneventful recovery Conclusion To the best of our knowledge, the presented case with traumatic pseudomeningocele is the first example secondary to high velocity bullet injury. Furthermore, management of traumatic intraspinal pseudomeningocele subsequent to root avulsion injury has not been paid sufficient attention. In this paper, the surgical strategy will be discussed in detail.
Collapse
Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Num. 10, Rastak St., Keshavarz Blvd, Tehran, Iran
- Corresponding author.
| | - Seyed Amirhossein Javadi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Enomoto N, Mure H, Okazaki T, Azumi M, Okita S, Nagahiro S, Takagi Y. Posttraumatic Cerebrospinal Fluid Leak Associated with an Upper Cervical Meningeal Diverticulum. World Neurosurg 2018; 116:50-55. [DOI: 10.1016/j.wneu.2018.05.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 12/13/2022]
|
4
|
Hamdan A, Saxena A, Rao G, Ivanov M. Compression of a giant pseudomeningocele causing transient anoxic seizures-a case report. Acta Neurochir (Wien) 2018; 160:479-485. [PMID: 29299677 DOI: 10.1007/s00701-017-3446-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Abstract
Transient anoxic seizure upon application of pressure on a giant pseudomeningocele has never been reported in the literature; such abrupt changes in intracranial pressure due to large volume of cerebrospinal fluid (CSF) translocation, if left untreated may lead to permanent cerebral hypoxic injury and death. Here we describe a case of a 26-year-old woman who had undergone lumbar disc surgery in another unit few months ago and developed a large lump around her back. Any pressure on the lump resulted in headaches and at times episodes of seizures. Clinical examination revealed a very large fluid-filled lump consistent with a giant pseudomeningocele, confirmed by an MRI. A video EEG while applying pressure on the lump was recorded. The patient developed a typical seizure attack with a characteristic pattern of cerebral anoxia, and a paired ECG showed irregular rhythm with junctional and ventricular ectopic beats during the latter part of the attack, raising a suspicion of asystole. Upon relieving the pressure off the lump, the patient gradually regained consciousness with no permanent neurological deficit. We then discuss the pathophysiology of anoxic seizures and highlight the need to be vigilant in managing patients with such lesions in order to prevent permanent cerebral hypoxic injury and death.
Collapse
Affiliation(s)
- Alhafidz Hamdan
- Department of Spinal Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - A Saxena
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Rao
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Ivanov
- Department of Spinal Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
5
|
Giant postsurgical pseudomeningocele by SPECT/CT cisternography. Clin Nucl Med 2014; 40:159-61. [PMID: 25188645 DOI: 10.1097/rlu.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a case of a 32-year-old man with a giant pseudomeningocele seen on MRI examination 6 months after spinal surgery. Radionuclide SPECT/CT cisternography performed after intrathecal suboccipital injection of In-DTPA identified the site of cerebral spinal fluid leak at the L4 level, and the patient underwent surgical correction of the dural defect. A repeat MRI examination 8 months later showed no signs of recurrence.
Collapse
|
6
|
Cools MJ, Al-Holou WN, Stetler WR, La Marca F, Valdivia-Valdivia JM. Anterior sacral pseudomeningocele following minimal trauma. J Neurosurg Spine 2013; 19:384-8. [DOI: 10.3171/2013.6.spine12956] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sacral fractures are rare and seldom result in formation of a sacral pseudomeningocele. Treatment of these pseudomeningoceles usually consists of conservative management with flat bedrest or open operative management. The authors describe the case of a 55-year-old woman with an anterior sacral pseudomeningocele that was successfully treated using a lumbar drain for temporary continuous CSF drainage. The patient first presented to an outside institution several days after sacral trauma from an ice skating fall. Initial symptoms included throbbing headaches relieved by lying flat. Head and cervical spine CT demonstrated no abnormality. As symptoms worsened, she presented to another institution where MRI of the lumbar spine indicated sacral fracture with pseudomeningocele. The patient subsequently transferred to the authors' facility, where symptoms included headaches and occasional mild sacral pain. Given her headaches and the authors' concern for CSF leak, another head CT scan was performed. This revealed no subdural hematoma or other abnormality. A subsequent CT myelogram revealed an anterior sacral pseudomeningocele at S3–4 with an anterior irregular linear filling defect, likely representing torn dura. Treatment included placement of a lumbar drain (10 ml/hr) and flat bedrest. Resolution of the CSF leak occurred on postprocedure Day 9. At the 4-week follow-up visit, the patient had no clinical symptoms of CSF leak and no neurological complaints. To our knowledge, this is the first description of temporary continuous CSF drainage used to treat a posttraumatic sacral pseudomeningocele. This technique may reduce the need for potentially complicated surgical repair of sacral fractures associated with CSF leak in select patients.
Collapse
|
7
|
Srilomsak P, Okuno K, Sakakibara T, Wang Z, Kasai Y. Giant pseudomeningocele after spinal surgery: A case report. World J Orthop 2012; 3:109-13. [PMID: 22816066 PMCID: PMC3399016 DOI: 10.5312/wjo.v3.i7.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/26/2012] [Accepted: 07/10/2012] [Indexed: 02/06/2023] Open
Abstract
Very few reports have described giant pseudomeningoceles ≥ 8 cm in diameter. We report this case of the biggest giant pseudomeningocele at the unusual cervicothoracic level. A 59 year old man who underwent cervicothoracic laminectomy had a giant pseudomeningocele detected and the lesion gradually grew to about 15 cm in diameter by 2 years postoperatively. Cerebrospinal fluid leak closure was performed and the postoperative course was favorable. We present this case, review the literature and discuss the size and portion, mechanism of formation, symptoms and treatments of giant pseudomeningocele.
Collapse
|
8
|
Banno T, Ohishi T, Suzuki D, Honda Y, Kobayashi S, Matsuyama Y. Traumatic sacral pseudomeningocele with spina bifida occulta. J Neurosurg Spine 2012; 16:78-81. [DOI: 10.3171/2011.8.spine11190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pseudomeningocele arises after spinal fracture and nerve root avulsion or after complications of spine surgery. However, traumatic pseudomeningocele with spina bifida occulta is rare. In this report, a traumatic pseudomeningocele in a patient with spina bifida occulta that required surgical treatment is documented. This 37-year-old man presented to the authors' hospital with headache and a fluctuant mass in the center of his buttocks. A CT scan with myelography and MR imaging of the sacral region revealed a large subcutaneous area of fluid retention communicating with the intradural space through a defect of the S-2 lamina. Because 3 months of conservative treatment was unsuccessful, a free fat graft was placed with fibrin glue to seal the closure of the defect, followed by 1 week of CSF drainage. This is the first report on traumatic pseudomeningocele with spina bifida occulta successfully treated in this manner.
Collapse
Affiliation(s)
| | | | | | - Yosuke Honda
- 1Department of Orthopaedic Surgery, Enshu Hospital; and
| | - Sho Kobayashi
- 2Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yukihiro Matsuyama
- 2Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
9
|
Sharma MS, Spinner RJ. Post-traumatic lumbar pseudomeningocele. Spine J 2011; 11:1079. [PMID: 22122840 DOI: 10.1016/j.spinee.2011.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/21/2011] [Indexed: 02/03/2023]
Affiliation(s)
- Manish S Sharma
- Department of Neurosurgery, Mayo Clinic, Gonda 8-214 South, Rochester, MN 55905, USA
| | | |
Collapse
|
10
|
Drzymalski DM, Tuli J, Lin N, Tuli S. Cervicothoracic intraspinal pseudomeningocele with cord compression after a traumatic brachial plexus injury. Spine J 2010; 10:e1-5. [PMID: 20869921 DOI: 10.1016/j.spinee.2010.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 08/06/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pseudomeningoceles are noted within the neural foramen after avulsion plexus injuries. We present the case of a cervicothoracic epidural pseudomeningocele with spinal cord compression 18 years after a brachial plexus injury. PURPOSE To present a case report of a patient and literature review on cases with epidural pseudomeningoceles. STUDY DESIGN Case report and review of the literature. METHODS Retrospective review of the medical records of a patient presenting with an epidural pseudomeningocele after a plexus injury. RESULTS A 37-year-old male presented with neurological decline 18 years after sustaining a brachial plexus injury. Magnetic resonance tomography revealed an epidural fluid collection from C5 to T7 with significant spinal cord compression. Surgical intervention initially involved fenestration of the cyst and then rhizotomies of the C7 and C8 roots resulting in resolution of his new symptoms. CONCLUSIONS Pseudomeningoceles are common after brachial plexus avulsion injury and are usually stable, causing no symptoms, other than plexus neuropathies. We are unaware of previous reports of a patient with a traumatic brachial plexus avulsion who developed a large cervicothoracic, symptomatic, spinal, epidural, intracanalicular pseudomeningocele with cord compression 18 years after the initial injury. Patients with prior trauma and known plexus injuries with development of new neurological symptoms should be evaluated for the rare case of intradural pseudomeningoceles. Preoperative imaging with computed tomography myelography is important to isolate and definitively treat the fistulous connection.
Collapse
|