Pseudohypoxic Brain Swelling: Report of 2 Cases and Introduction of the Lentiform Rim Sign as Potential MRI Marker

Sotoudeh, Houman; Chapman, Philip R.; Sotoudeh, Ehsan; Singhal, Aparna; Choudhary, Gagandeep; Shafaat, Omid

doi:10.1016/j.wneu.2019.10.018

Cited by 8 publications

(19 citation statements)

References 25 publications

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“…8,22 More recently, other terms such as postoperative hypotension-associated venous congestion or paradoxical brain herniation have been used to describe presentations in which clinical and MRI descriptions are variable, but a decrease in the brain or CSF volume is common to all cases. 23 The objective of the treatment of IH is to improve the intracranial volume and to stop the CSF leak. The initial medical treatment includes bed rest (flat posture), oral hydration, 9,12,22 head down and elevated feet posture (Trendelenburg position) 9 , caffeine, corticosteroids, 8,22 and theophylline.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging findings and clinical management of suspected intracranial hypovolemia after transfrontal craniotomy in a dog

et al. 2021

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To report the diagnosis and clinical management of a case of suspected intracranial hypovolemia (IH) in a dog after resection of a large fronto-olfactory chordoid meningioma.Study design: Clinical case report.Animal: One 8-year-old border collie with forebrain neurological signs caused by a fronto-olfactory extra-axial mass diagnosed by using MRI. Methods:The dog underwent bilateral transfrontal craniotomy for excision of the mass by using ultrasonic aspiration. Immediate postsurgical MRI revealed complete gross resection with no evidence of early-onset complications such as edema, hemorrhage, mass effect, or pneumoencephalus. However, diffuse symmetric meningeal thickening and contrast enhancement were noted. No complications were noted during surgery or while under anesthesia. Results: Neurological deterioration was observed postoperatively. No abnormalities were detected systemically. Thus, early MRI-confirmed findings and neurological deterioration were suspected to be caused by IH. Conservative treatment consisting of bed rest, gabapentin, and intravenous theophylline was then initiated in addition to steroids, antiepileptic drugs, and antibiotics. A gradual neurological improvement was observed, and the dog was discharged completely ambulatory with moderate proprioceptive ataxia 15 days after surgery. Conclusion:The clinical and MRI-confirmed findings reported here are consistent with IH, a well-described syndrome in man. This is the first report of a dog with MRI-confirmed findings consistent with IH describing subsequent response to medical management. Clinical significance: Intracranial hypovolemia after craniotomy should be considered when there is neurological deterioration and characteristic MRIconfirmed findings.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging findings and clinical management of suspected intracranial hypovolemia after transfrontal craniotomy in a dog

et al. 2021

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“…Postoperative intracranial hypotension-associated venous congestion is a rare complication after lumbar laminectomy that mimics typical hypoxic ischaemic encephalopathy [1][2][3][4][5][6]. It usually occurs after loss of significant amounts of CSF following spinal or cerebral surgery with intended or unintended opening of the dura mater.…”

Section: Discussionmentioning

confidence: 99%

Fatal postoperative intracranial hypotension‐associated venous congestion after elective laminectomy

Schopmeyer

Sindhunata

Drogt-Bilaseschi

et al. 2021

Anaesthesia Reports

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Postoperative intracranial hypotension-associated venous congestion is a rare complication that features radiologic characteristics suggestive of hypoxic ischaemic encephalopathy without systemic hypoxia or hypotension actually occurring. This makes the condition prone to being misidentified as a complication of anaesthesia. In this case, a patient undergoing emergency haematoma evacuation after a previous lumbar laminectomy lost cerebrospinal fluid rapidly and accidentally via a wound drain. She subsequently developed postoperative seizures and eventually died some days later having never regained consciousness. A magnetic resonance imaging scan acquired after the event showed signs initially thought to be indicative of hypoxic ischaemic encephalopathy but was later identified to be postoperative intracranial hypotension-associated venous congestion due to temporary obstruction of the great cerebral vein, resulting in local rather than systemic hypoxia. Anaesthetists should be aware of this rare condition and be familiar with its pathophysiology and presentation.

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“…The timely cessation of any operation that causes a reduction in cerebrospinal fluid and placing the patient in the Trendelenburg position can relieve the symptoms of the patients. From the aspect of neuroimaging, low density (CT) and high signal (MRI) may be present in the basal ganglia, thalamus, cerebellum, and other anatomical areas (43). Therefore, better identification will allow the further exploration of primary brain swelling.…”

Section: Discussionmentioning

confidence: 99%

Increase in Brain Volume After Aneurysmal Subarachnoid Hemorrhage Leads to Unfavorable Outcome: A Retrospective Study Quantified by CT Scan

et al. 2021

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Background and Purpose: Primary brain swelling occurs in aneurysmal subarachnoid hemorrhage (aSAH) patients. The absence of a dynamic quantitative method restricts further study of primary brain swelling. This study compared differences in the change rate of brain volume (CRBV) between patients with and without primary brain swelling in the early stage of aSAH. Moreover, the relationship between CRBV and clinical outcomes was evaluated.Methods: Patients hospitalized within 24 h after aSAH were included in this retrospective study. Utilizing a qualitative standard established before the study to recognize primary brain swelling through brain CT after aSAH, clinical outcomes after 3 months of SAH were evaluated with a modified Rankin scale (mRS). The brain volume (BV) of each patient was calculated with a semiautomatic threshold algorithm of 3D-slicer, and the change in brain volume (CIBV) was obtained by subtracting the two extreme values (CIBV = BVmax – BVmin). The CRBV was obtained by CIBV/BVmin × 100%. The CRBV values that predicted unfavorable prognoses were estimated.Results: In total, 130 subjects were enrolled in the study. The mean CRBV in the non-swelling group and swelling group were 4.37% (±4.77) and 11.87% (±6.84), respectively (p < 0.05). CRBV was positively correlated with the length of hospital stay, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume (Spearman ρ = 0.334; p < 0.001; Pearson ρ = 0.269, p = 0.002; Pearson ρ = 0.278, p = 0.001; Pearson ρ = 0.233, p = 0.008, respectively). Analysis of variance showed significant differences in CIBV, CRBV, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume among varying modified Fisher scale (mFisher), with higher admission mFisher scale, indicating larger values of these variables. After adjusting for risk factors, the model showed that for every 1% increase in the CRBV, the probability of poor clinical prognosis increased by a factor of 1.236 (95% CI = 1.056–1.446). In the stratified analysis, the odds of worse clinical outcomes increased with increases in the CRBV. Receiver operating characteristic curve analysis showed that HH grade, mFisher scale, and score of CRBV (SCRBV) had diagnostic performance for predicting unfavorable clinical outcomes.Conclusion: Primary brain swelling increases brain volume after aSAH. The CRBV quantified by 3D-Slicer can be used as a volumetric representation of the degree of brain swelling. A larger CRBV in the early stage of aSAH is associated with poor prognosis. The CRBV can be used as a neuroimaging biomarker of early brain injury after bleeding and may be an effective predictor of patients' clinical prognoses.

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Pseudohypoxic Brain Swelling: Report of 2 Cases and Introduction of the Lentiform Rim Sign as Potential MRI Marker

Cited by 8 publications

References 25 publications

Magnetic resonance imaging findings and clinical management of suspected intracranial hypovolemia after transfrontal craniotomy in a dog

Magnetic resonance imaging findings and clinical management of suspected intracranial hypovolemia after transfrontal craniotomy in a dog

Fatal postoperative intracranial hypotension‐associated venous congestion after elective laminectomy

Increase in Brain Volume After Aneurysmal Subarachnoid Hemorrhage Leads to Unfavorable Outcome: A Retrospective Study Quantified by CT Scan

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