Spontaneous intracranial hypotension complicated with cerebral venous thrombosis and subdural effusion: a case report (original) (raw)
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Neurological Sciences, 2010
We report a patient with clinical and neuroimaging findings of spontaneous intracranial hypotension (SIH) who developed cerebral venous thrombosis (CVT). An association between SIH and CVT has rarely been observed. Anticoagulation therapy was administered. The clinical course was subsequently complicated by a large subdural hematoma that required neurosurgical evacuation. The present report indicates that SIH should not be always considered a benign condition, especially when associated with CVT and subdural fluid collections. Furthermore, clinicians should be aware of the potential risks of anticoagulant therapy in patients with SIH and CVT.
Annals of Indian Academy of Neurology, 2013
A 35 year old Chinese man experienced severe generalized headache over a couple of days. The headache was throbbing in nature and maximum in the posterior parietal regions. In addition, he also complained of double vision, neck pain and dizziness; however, denied having nausea or vomiting. The headaches were aggravated when he assumed an upright posture (sitting or standing) and alleviated when lying down. He did not have preceding history of strenuous physical activities such as heavy weight lifting, trauma or a lumbar puncture procedure. Neurological examination revealed bilateral mild restriction of lateral gaze (likely due to VI nerve involvement), which resulted in binocular diplopia on extreme horizontal gaze. His brain computed tomography with contrast was normal.MRI brain showed prominence of cortical veins and significant distension of dural venous sinuses raising the possibility of pachymeningitis without venous sinus thrombosis [Figure 1 a,b]. In addition, cervical spine MRI revealed engorged anterior epidural venous plexus at cranio cervical junction and upper cervical spine, with mild effacement of the subarachnoid space, raising the possibility of spontaneous intracranial hypotension secondary to cerebrospinal fluid (CSF) leak; however, no nerve root diverticula was noted. Repeated lumbar puncture (LP) failed to extract any CSF. Subsequently, LP under fluoroscopic guidance confirmed a low CSF pressure (5 cm of water). The routine CSF investigations for infective and inflammatory markers were all negative.
The Journal of international medical research, 2016
Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11-L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12-L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinic...
Journal of the Chinese Medical Association : JCMA, 2012
A 36-year-old male had spontaneous intracranial hypotension (SIH) presenting with refractory headache for 4 months. Multiple epidural blood patches (EBPs) yielded relief of symptoms, but the course was complicated, with asymptomatic intracranial subdural hematoma (SDH). Except for SDH, other radiological diagnostic signs of SIH were resolved and the patient's headaches improved after EBP. Owing to a mass effect and persistent cerebrospinal fluid (CSF) leakage, surgical repair of the spinal leakage was performed, but no cranial procedures were carried out. Postoperatively, the SDH completely resolved, but there was still CSF leakage at the level where surgery was performed. The patient has remained free of headache or other events for 3 years. It was reduction rather than elimination of the spinal CSF leak that yielded remission of SIH. In summary, intracranial SDH can be a complication of inadequately treated SIH (i.e. persistent minor CSF leakage). Management of SDH should focus on correction of the underlying SIH rather than craniotomy for hematoma evacuation.
Headache: The Journal of Head and Face Pain, 2020
Background.-The typical sign of intracranial hypotension (IH) is postural headache. However, IH can be associated with a large diversity of clinical or radiological signs leading to difficult diagnosis especially in case of coma. The association of cerebral venous thrombosis (CVT) and subdural hemorrhage is rare but should suggest the diagnosis of IH. Methods.-Case report. Case Description.-We report here a case of comatose patient due to spontaneous IH complicated by CVT and subdural hemorrhage. The correct diagnosis was delayed due to many confounding factors. IH was suspected after subdural hemorrhage recurrence and confirmed by magnetic resonance imaging (MRI). After 2 epidural patches with colloid, favorable outcome was observed. Discussion.-The most common presentation of IH is postural orthostatic headaches. In the present case report, the major clinical signs were worsening of consciousness and coma, which are a rare presentation. Diagnosis of IH is based on the association of clinical history, evocative symptomatology, and cerebral imaging. CVT occurs in 1-2% of IH cases and the association between IH, CVT, and subdural hemorrhage is rare. MRI is probably the key imaging examination. In the present case, epidural patch was performed after confounding factors for coma had been treated. Benefit of anticoagulation had to be balanced in this case with potential hemorrhagic complications, especially within the brain. Conclusion.-Association of CVT and subdural hemorrhage should lead to suspect IH. Brain imaging can help and find specific signs of IH.
Arquivos de Neuro-Psiquiatria
Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods Review of the medical files of three patients and description of clinical and surgical outcomes. Results Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed to...
International Journal of General Medicine, 2014
Spontaneous intracranial hypotension is an infrequent cause of secondary headache due to cerebrospinal fluid (CSF) hypovolemia. Objective: To describe a case of headache revealing spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture. Observation: A 34-year-old man presented with acute postural headache. The first cerebral computed tomography scan was normal. Lumbar puncture showed hyperproteinorachy at 2 g/L with six lymphocytic cells. The headache became very intense. At admission, clinical examination was normal. Ophthalmological examination did not show any abnormalities. Encephalic magnetic resonance imaging (MRI) showed bilateral subdural hematoma with tonsillar descent simulating Chiari type I malformation. After surgical drainage and symptomatic treatment, the patient was discharged with no recurrence. Conclusion: Spontaneous intracranial hypotension is associated with simple clinical presentation, orthostatic headache, and characteristic MRI findings. Misdiagnosed, it leads to unnecessary procedures.
Spontaneous intracranial hypotension: Two cases including one treated with epidural blood patch
Annals of Indian Academy of Neurology, 2009
of migraine. He had been experiencing a diff erent type of a more severe, persistent, nuchal and occipital headache since the last three weeks. The pain was nonthrobbing and unassociated with nausea or vomiting. It had developed over a week and had slowly grown in intensity, and had begun to bother his work while he sat in his offi ce chair. It would begin within 15 minutes of sitt ing or standing, and subside within 30 minutes aft er lying down. He would notice a peculiar feeling of "something moving inside his head" when he would sit up or stand. The past history was remarkable for a shoulder dislocation suff ered three years ago. Examination showed subtle marfanoid features such as tall stature and long slender fi ngers. Neurological examination was normal. MRI brain showed bilateral subdural hygromas, "sagging" of the brainstem [Figure 1], DPME, and engorged venous sinuses. Routine MRI spine revealed a CSF leak at T6 vertebral level with a localized CSF collection in the posterior right epidural space [Figure 2]. The patient was treated with bed rest and liberal fl uid intake for four weeks with complete symptomatic relief. He was able to resume his normal activities thereaft er and had no recurrence of symptoms. One year later, follow-up MRI showed almost complete resolution of subdural collections, and signifi cantly less brainstem "sagging". MRI spine findings, however, remained unchanged.