An atypical case of spontaneous intracranial hypotension

Balgera, Roberto; Rigamonti, Andrea; Sozzi, G.; Agostoni, Elio

doi:10.1007/s10072-009-0011-4

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…Some of the early consequences that have been described are rare and unexpected such as chorea, radicular pain in upper limbs, coma, encephalopathy, bulbar symptoms, facial numbness and weakness and gait impairment [1,7,8]. Long term problems and late sequelae of CSF leaks are not well recognized.…”

Section: Discussionmentioning

confidence: 96%

Anterior horn cell loss from subdural hygroma: A consequence of spontaneous spinal fluid leak

Mihaylova

Biondo²,

Zak³

et al. 2011

Journal of the Neurological Sciences

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Section: Discussionmentioning

confidence: 96%

Anterior horn cell loss from subdural hygroma: A consequence of spontaneous spinal fluid leak

Mihaylova

Biondo²,

Zak³

et al. 2011

Journal of the Neurological Sciences

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“…The predominant symptom of this syndrome is postural headache of acute onset, which is slight when the patient is lying down but rapidly worsens when the patient sits or stands. The headache can be so severe that it can be classified under the rubric of ‘thunderclap headache’ such as occurs with subarachnoid haemorrhage 8 . Sufferers from the syndrome may only complain of non‐postural headaches 9 .…”

Section: Symptoms and Signsmentioning

confidence: 99%

Spontaneous intracranial hypotension

Gordon¹

2009

Develop Med Child Neuro

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Since the introduction of magnetic resonance imaging (MRI), spontaneous intracranial hypotension has been diagnosed much more frequently. The aim of this review is to discuss the symptoms and signs of the condition, in particular the characteristics of the associated headache, with sudden onset after sitting or standing, so that it can be included under the rubric of ‘thunderclap headache’. This type of headache, like post lumbar puncture headaches, may be caused by cerebral vasodilatation and exacerbated by lowered pressure of the cerebrospinal fluid (CSF). Other symptoms include neck stiffness, nausea, vomiting, vertigo, tinnitus, deafness, and cognitive abnormalities. The clinical picture can sometimes mimic frontotemporal dementia, and the behaviour of some patients can sometimes be described as hypoactive–hypoalert, with somnolence, impaired attention, and stereotyped motor activity. Sagging of the brain, caused by leakeage of the CSF, can cause lesions in the brainstem with stupor, gaze palsies, and cranial nerve palsies. The condition can be a risk factor for cerebral venous thrombosis because of slowing of the blood flow and distortion of the blood vessels. The clinical picture may well suggest the diagnosis, but the headache may possibly indicate a subarachnoid haemorrhage. However, MRI will help to confirm the diagnosis and to localize the site of the CSF leak. MRI myelograms are of particular value, but if they are equivocal a computed tomography myelogram should be performed. The leakage of CSF is due to a tear in the dura, most frequently where the spinal roots leave the subarachnoid space. If this does not heal with bedrest, an epidural blood patch or a percutaneous injection of fibrin glue may be needed. More information is required on long‐term follow‐up.

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“…The rarer manifestations of CSF hypovolemia includes chorea, radicular pains in upper limbs, encephalopathy, bulbar palsy, facial numbness with weakness and gait abnormalities. 1,10,11 Our patient had none of these unusual features reported to occur in intracranial hypotension.…”

Section: Discussionmentioning

confidence: 50%

Ventral longitudinal intraspinal fluid collection: Rare presentation as brachial amyotrophy and intracranial hypotension

Preethish‐Kumar

Vengalil

Tiwari

et al. 2017

The Journal of Spinal Cord Medicine

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A 31 year old man presented with severe positional neck discomfort, radiating pain, progressive asymmetrical wasting and weakness of distal upper limbs. Contrast Magnetic Resonance Imaging (MRI) of the spine demonstrated a ventral extradural intraspinal fluid collection extending from upper border of C6 to lower border of T3 vertebra with pockets of dorsal collection. Three-dimensional constructive interference in steady state (CISS 3D) used in spinal imaging for identification of CSF leak corroborated with the extent seen on T2 sagittal sections; however, the site of the leak was not identified. After a year he developed disturbing postural headache which was relieved in recumbent position. Follow up MRI of brain was normal while spine demonstrated significant cervical cord atrophy and bilateral cord white matter hyperintensities. Conclusion / Clinical Relevance: We report this unusual case where local compression by VLISFC located at the cervical and upper thoracic level not only caused distal bi-brachial amyotrophy mimicking Hirayama disease but also led to secondary intracranial hypotension. An early identification and intervention could possibly have prevented the onset of ICH.

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An atypical case of spontaneous intracranial hypotension

Cited by 9 publications

References 8 publications

Anterior horn cell loss from subdural hygroma: A consequence of spontaneous spinal fluid leak

Anterior horn cell loss from subdural hygroma: A consequence of spontaneous spinal fluid leak

Spontaneous intracranial hypotension

Ventral longitudinal intraspinal fluid collection: Rare presentation as brachial amyotrophy and intracranial hypotension

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