Repeated Deterioration of Consciousness Resulting from Spontaneous Intracranial Hypotension Associated with Deep Cerebral Vein Stagnation

Uchino, Haruto; Hamada, Saori; Kashiwazaki, Daina; Tomita, Takahiro; Akioka, Naoki; Akai, Takuya; Kuroda, Satoshi

doi:10.1016/j.wneu.2019.09.062

Cited by 6 publications

(9 citation statements)

References 4 publications

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“…[5][6][7] By contrast, the characteristic meningeal enhancement associated with IH is diffuse, extends symmetrically over the entire meningeal surface, and affects only the pachymeninges. 1,[9][10][11][12][13]16 In the dog described in our case report, a diffuse pachymeningeal enhancement not limited to the surgical margins was present, compatible with the IH enhancement. However, a focal leptomeningeal enhancement restricted to the frontal lobes was also appreciated, which was associated with surgical manipulation.…”

Section: Discussionmentioning

confidence: 85%

“…In severe cases, the clinical course can result in deterioration of consciousness or coma. [8][9][10]12 Some of these signs will be unnoticed in dogs; therefore, IH would be evident only when neurological deficits are present. In our case, IH was clinically compatible because, as in man, our dog exhibited deteriorating neurological status after dynamic movements (after physiotherapy exercises) concomitant with increased nasal leak (compatible with CSF rhinorrhea), and the neurological recovery was not as expected with no other identified or suspected cause.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the IH results in loss of buoyancy and downward displacement of the brain. 14 The sagging brain could explain the neurological deterioration seen in cases of IH 11,12 ; nevertheless, it also could be secondary to brain perfusion changes 12 (Figure 5).…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging-confirmed findings in human patients with IH are broadly described in the literature and can include (1) diffuse thick pachymeningeal enhancement after gadolinium administration [8][9][10][11][12][13] ; (2) subtle changes of downward displacement of the brainstem and cerebellum, with third ventricle collapse 8-12 ; (3) occasional focal subdural fluid collections (named subdural hygroma) [8][9][10]12 ; and (4) increased crowding of the posterior fossa if IH progresses, resulting in tonsillar herniation. 9,11 To the best of the authors' knowledge, this is the first report of suspected postoperative IH in a dog.…”

Section: Introductionmentioning

confidence: 97%

“…[5][6][7] Intracranial hypovolemia (IH) is a well-characterized syndrome in human medicine that results from abnormally low intracranial volume, 8 commonly secondary to a low cerebrospinal fluid (CSF) volume, and is associated with variable neurological signs and typical MRIconfirmed abnormalities. 9,10 Intracranial hypovolemia is usually associated with CSF leakage, 11,12 for example, secondary to over-shunting after ventriculoperitoneal shunt placement 13 or after brain 14 or spinal procedures including lumbar drainage, spinal anesthesia, or surgery. 9 Intracranial hypovolemia has not been described previously in nonexperimental dogs.…”

Section: Introductionmentioning

confidence: 99%

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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: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Epidural Blood Patching in Spontaneous Intracranial Hypotension—Do we Really Seal the Leak?

et al. 2022

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Purpose Epidural blood patch (EBP) is a minimally invasive treatment for spontaneous intracranial hypotension (SIH). Follow-up after EBP primarily relies on clinical presentation and data demonstrating successful sealing of the underlying spinal cerebrospinal fluid (CSF) leak are lacking. Our aim was to evaluate the rate of successfully sealed spinal CSF leaks in SIH patients after non-targeted EBP. Methods Patients with SIH and a confirmed spinal CSF leak who had been treated with non-targeted EBP were retrospectively analyzed. Primary outcome was persistence of CSF leak on spine MRI or intraoperatively. Secondary outcome was change in clinical symptoms after EBP. Results In this study 51 SIH patients (mean age, 47 ± 13 years; 33/51, 65% female) treated with non-targeted EBP (mean, 1.3 EBPs per person; range, 1–4) were analyzed. Overall, 36/51 (71%) patients had a persistent spinal CSF leak after EBP on postinterventional imaging and/or intraoperatively. In a best-case scenario accounting for missing data, the success rate of sealing a spinal CSF leak with an EBP was 29%. Complete or substantial symptom improvement in the short term was reported in 45/51 (88%), and in the long term in 17/51 (33%) patients. Conclusion Non-targeted EBP is an effective symptomatic treatment providing short-term relief in a substantial number of SIH patients; however, successful sealing of the underlying spinal CSF leak by EBP is rare, which might explain the high rate of delayed symptom recurrence. The potentially irreversible and severe morbidity associated with long-standing intracranial hypotension supports permanent closure of the leak.

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Delayed recurrence of spontaneous intracranial hypotension syndrome mimicking a Chiari I malformation: Case report with a review of the literature

2021

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Repeated Deterioration of Consciousness Resulting from Spontaneous Intracranial Hypotension Associated with Deep Cerebral Vein Stagnation

Cited by 6 publications

References 4 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

Epidural Blood Patching in Spontaneous Intracranial Hypotension—Do we Really Seal the Leak?

Delayed recurrence of spontaneous intracranial hypotension syndrome mimicking a Chiari I malformation: Case report with a review of the literature

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