Spontaneous CSF Collection in the Cervical Spine may Cause Neurological Deficit and Intra-cranial Hypotension

Zakaria, Rasheed; Wilby, Martin; Fletcher, Nicholas

doi:10.2174/1874205x01307010001

Cited by 9 publications

(4 citation statements)

References 3 publications

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“…Long wave infrared (IR) imaging in the range of 7.5–13.5μm provides data for overall tissue perfusion and has been proven experimentally to assess tissue function and metabolism. [ 5 ] In addition to their low cost in comparison to other imaging technologies, both 3CCD imaging and long wave IR imaging do not rely on extrinsic enhancement with injectable dyes or contrast agents.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia

et al. 2015

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Acute limb ischemia is a common cause of morbidity and mortality following trauma both in civilian centers and in combat related injuries. Rapid determination of tissue viability and surgical restoration of blood flow are desirable, but not always possible. We sought to characterize the response to increasing periods of hind limb ischemia in a porcine model such that we could define a period of critical ischemia (the point after which irreversible neuromuscular injury occurs), evaluate non-invasive methods for characterizing that ischemia, and establish a model by which we could predict whether or not the animal’s locomotion would return to baselines levels post-operatively. Ischemia was induced by either application of a pneumatic tourniquet or vessel occlusion (performed by clamping the proximal iliac artery and vein at the level of the inguinal ligament). The limb was monitored for the duration of the procedure with both 3-charge coupled device (3CCD) and infrared (IR) imaging for tissue oxygenation and perfusion, respectively. The experimental arms of this model are effective at inducing histologically evident muscle injury with some evidence of expected secondary organ damage, particularly in animals with longer ischemia times. Noninvasive imaging data shows excellent correlation with post-operative functional outcomes, validating its use as a non-invasive means of viability assessment, and directly monitors post-occlusive reactive hyperemia. A classification model, based on partial-least squares discriminant analysis (PLSDA) of imaging variables only, successfully classified animals as “returned to normal locomotion” or “did not return to normal locomotion” with 87.5% sensitivity and 66.7% specificity after cross-validation. PLSDA models generated from non-imaging data were not as accurate (AUC of 0.53) compared the PLSDA model generated from only imaging data (AUC of 0.76). With some modification, this limb ischemia model could also serve as a means on which to test therapies designed to prolong the time before critical ischemia.

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Section: Introductionmentioning

confidence: 99%

Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia

et al. 2015

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“…Cases of SADD revealed by BA are less frequent than those associated with intracranial hypotension or SS, with only 18 patients reported in the literature. 8,9,[11][12][13][14][15][16][17][18] However, our hypothesis is that BA is yet another clinical presentation of the same entity, as evidenced by several reports combining a motor deficit of the upper limbs and either SIH 11,14,16 or SS. 9,15 Therefore, we propose a unifying approach in which a single etiology (SADD) can be revealed by multiple clinical presentations: BA (SADD-BA), SIH (SADD-SIH), or SS (SADD-SS) (Table 3).…”

Section: Discussionmentioning

confidence: 86%

“…We found 18 cases of SADD revealed by BA published in the literature, mostly case reports and small case series 8,9,[11][12][13][14][15][16][17][18] (Table 2). Notably, all patients were men, aged between 26 and 68 years, presenting with a slowly progressing bibrachial motor deficit of the upper limbs.…”

Section: Systematic Reviewmentioning

confidence: 99%

Spinal Anterior Dural Dissection: Moving From Differential to Unifying Diagnosis

Knafo,

Herbrecht,

Cauquil

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Cerebrospinal fluid (CSF) collections extending longitudinally at the anterior aspect of the spinal dura have been reported in association with various conditions and under multiple names. The aim of this study was to report cases associated with brachial amyotrophy (BA) and examine its relationship with other clinical variants. METHODS: We conducted a retrospective cohort study including patients who presented with a motor deficit of the upper limbs and an anterior interdural CSF collection on spinal MRI. We performed a systematic review of the literature to include cases revealed by BA. RESULTS: Seven patients presenting with BA and a confirmed dural dissection on spinal MRI were included. All patients were male with a slowly progressing history of asymmetrical and proximal motor deficit of the upper limbs. Chronic denervation affecting mostly C5 and C6 roots was found on electroneuromyography. Spinal MRI demonstrated an anterior CSF collection dissecting the interdural space and exerting a traction on cervical motor roots. Dynamic computed tomography myelogram localized the dural defect every time it was performed (4/7 cases), and surgical closure was possible for 3 patients, leading to resolution of the collection. Literature review yielded 18 other published cases of spinal dural dissections revealed by BA, including 4 in association with spontaneous intracranial hypotension and 4 others in association with superficial siderosis. CONCLUSION: We propose a unifying diagnosis termed “spinal anterior dural dissection” (SADD) to encompass spinal dural CSF collections revealed by BA (SADD-BA), spontaneous intracranial hypotension (SADD-SIH), or superficial siderosis (SADD-SS).

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“…IH is frequently associated with a cerebral SDH (10%–69%) as in case I (de Noronha et al 2003 ). IH with subdural cervical fluid (case II) collections in a trauma context is rare (Ferrante et al 2011 ) than spontaneous IH (Zakaria et al 2013 ). The true mechanism of the development of SDH or hygroma due to intracranial hypotension is still unknown but there have been hypotheses proposed.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

Intracranial hypotension after trauma

Sarrafzadeh¹,

Hopf²,

Gautschi³

et al. 2014

SpringerPlus

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IntroductionIntracranial hypotension (IH) occurs typically spontaneous and is a potentially life-threatening condition characterized by symptoms varying from postural headache to coma, with classical magnetic resonance imaging (MRI) findings.Case descriptionWe report two cases of clinically relevant trauma-related IH and review of the literature.One patient with a cerebral trauma presented unilateral mydriasis and coma resolved by the Trendelenburg position (-20°) as urgency intervention. In the second patient, IH was caused by a lesion of the brachial plexus after a motor vehicle accident.Discussion and conclusionA history of mild or moderate trauma in association with prolonged postural or permanent headache may indicate IH. Posttraumatic IH is rare, nevertheless life-threatening in case of misdiagnosis. Intracranial hypotension in a trauma context is rarely described and difficult to diagnose. The change from tipical supine 30° to Trendelenburg position (0–20°) can be a life-saving manoeuver in these patients.

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Spontaneous CSF Collection in the Cervical Spine may Cause Neurological Deficit and Intra-cranial Hypotension

Cited by 9 publications

References 3 publications

Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia

Noninvasive Multimodal Imaging to Predict Recovery of Locomotion after Extended Limb Ischemia

Spinal Anterior Dural Dissection: Moving From Differential to Unifying Diagnosis

Intracranial hypotension after trauma

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