Compression of a giant pseudomeningocele causing transient anoxic seizures—a case report

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.

Decompression of a giant cranial pseudomeningocele causing haemiparesis and focal seizures

“…This sudden reduction in pressure, likely resulted in a significant increase in local blood flow, subsequent venous congestion and vasogenic brain oedema. A similar pathophysiology has been suggested for postoperative intracranial hypotension-associated venous congestion (PIHV) 2–4. We believe this case represents a spectrum of the same disease process.…”

Giant Lumbar Pseudomeningocele Compression Mimicking Stroke and Seizure

“…Few cases of pseudomeningocele compression causing increased intracranial pressure and presenting with loss of consciousness have been described in the literature. [4][5][6][7] One other case of convulsive syncope on pseudomeningocele compression without sequelae has been documented. 4 As in our case, the symptoms were correlated to simultaneous diffuse flattening of the EEG; however, the reported simultaneous cardiac arrhythmia with ectopic ventricular beats 4 was not observed in our case.…”

“…[4][5][6][7] One other case of convulsive syncope on pseudomeningocele compression without sequelae has been documented. 4 As in our case, the symptoms were correlated to simultaneous diffuse flattening of the EEG; however, the reported simultaneous cardiac arrhythmia with ectopic ventricular beats 4 was not observed in our case. In other cases, the effects were irreversible with prolonged compression causing retinal hemorrhage in 1 case 5 and diffuse cerebral ischemic lesions in another.…”

Giant lumbar postoperative pseudomeningocele inducing positional syncope

“…The majority of the postoperative pseudomeningoceles occurring after lumbar spine surgeries are small, asymptomatic and resolve spontaneously 5. However, some patients may present different neurological manifestations, which may appear in a time frame that varies from a few months to several years after the surgery 5–13. According to the few cases previously reported, positional syncope is a rare presentation, which may be accompanied by paroxystic movements, headache, transient neurological deficits, between others 6 10–12 14 15.…”