Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases

Hasıloğlu, Zehra Işık; Abuzayed, Bashar; Imal, Ahmet Esat; Cagil, Emin; Albayram, Sait

doi:10.1007/s00586-011-1828-0

Cited by 23 publications

(5 citation statements)

References 20 publications

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“…51,52 Rarely, the dura mater may be physically eroded by spinal osteophytes. 8,22,66,68 Intracranial hypotension presenting as severe depression of mental status or coma is unusual but has been reported multiple times in the literature (Table 1).…”

Section: Jns112030) Abstract • Coma • Cerebrospinal Fluid Leak • Epmentioning

confidence: 99%

Intracranial hypotension producing reversible coma: a systematic review, including three new cases

Loya¹,

Mindea²,

Yu³

et al. 2012

JNS

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Intracranial hypotension is a disorder of CSF hypovolemia due to iatrogenic or spontaneous spinal CSF leakage. Rarely, positional headaches may progress to coma, with frequent misdiagnosis. The authors review reported cases of verified intracranial hypotension-associated coma, including 3 previously unpublished cases, totaling 29. Most patients presented with headache prior to neurological deterioration, with positional symptoms elicited in almost half. Eight patients had recently undergone a spinal procedure such as lumbar drainage. Diagnostic workup almost always began with a head CT scan. Subdural collections were present in 86%; however, intracranial hypotension was frequently unrecognized as the underlying cause. Twelve patients underwent one or more procedures to evacuate the collections, sometimes with transiently improved mental status. However, no patient experienced lasting neurological improvement after subdural fluid evacuation alone, and some deteriorated further. Intracranial hypotension was diagnosed in most patients via MRI studies, which were often obtained due to failure to improve after subdural hematoma (SDH) evacuation. Once the diagnosis of intracranial hypotension was made, placement of epidural blood patches was curative in 85% of patients. Twenty-seven patients (93%) experienced favorable outcomes after diagnosis and treatment; 1 patient died, and 1 patient had a morbid outcome secondary to duret hemorrhages. The literature review revealed that numerous additional patients with clinical histories consistent with intracranial hypotension but no radiological confirmation developed SDH following a spinal procedure. Several such patients experienced poor outcomes, and there were multiple deaths. To facilitate recognition of this treatable but potentially life-threatening condition, the authors propose criteria that should prompt intracranial hypotension workup in the comatose patient and present a stepwise management algorithm to guide the appropriate diagnosis and treatment of these patients.

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Section: Jns112030) Abstract • Coma • Cerebrospinal Fluid Leak • Epmentioning

confidence: 99%

Intracranial hypotension producing reversible coma: a systematic review, including three new cases

Loya¹,

Mindea²,

Yu³

et al. 2012

JNS

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“…It can be observed that 77 % of these cases were caused by trauma of varying aetiologies and only two (4.5 %) of the cases were described as subsequent to post-operative thoracic disc resection [2,9,[14][15][16][17]. Recently, two cases of spontaneous thoracic CSF leakage in the presence of thoracic disc hernias were described [18]. It must be concluded that subarachnoid-pleural fistula subsequent to an anterior resection of thoracic disc is a very rare entity.…”

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

et al. 2013

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Background Thoracic cerebrospinal fluid (CSF) hygroma is a rare and potentially devastating complication of the anterior thoracic approach to the spine. We present two cases in which this complication resulted in acute cranial nerve palsy and discuss the pathoanatomy and management options in this scenario. Case reports Two male patients presented to our department with neurological deterioration due to a giant herniated thoracic disc. The extruded disc fragment was noted preoperatively to be calcified in both patients. A durotomy was performed at primary disc prolapse resection in the first patient, whereas an incidental durotomy during the

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“…While dural tear may occur anywhere along the spinal axis, laceration, and subsequent CSF leakage at the nerve root sleeve may be relatively rare: PubMed search using the keywords IC and root sleeve yielded only seven previous cases [ Table 1 ]. [ 15 16 17 18 19 20 21 ] As shown in Figure 2b , reconstructed coronal view of the CT myelogram may particularly be useful to identify CSF leakage occurring at the root sleeve.…”

Section: Discussionmentioning

confidence: 99%

“…Year of publication Spinal level Pleasure et al [15] 1998 Lumbar Schievink and Jacques [16] 2003 Cervical Watanabe et al [17] 2009 Thoracic Ohtonari et al [18] 2009 Lumbar Cheshire and Wharen [19] 2009 Cervical Hasiloglu et al [20] 2012 Thoracic/thoracic Tontisirin et al [21] 2018 Thoracic Present case 2018 Thoracic…”

Section: Authormentioning

confidence: 99%

Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient

2019

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We present a rare case of traumatic acute subdural hematoma (SDH) in which intracranial hypotension (IC) secondary to cerebrospinal fluid (CSF) leakage at the lumbar spine caused delayed neurological deterioration. A 70-year-old male sustained a head injury after ground-level fall and was brought to our institution. A brain computed tomography (CT) showed a thin acute SDH with mild brain shift, and conservative management was initiated. He exhibited neurological deterioration on the 9th hospital day, however, and a brain CT showed a change in CT density and marked an increase in hematoma volume and brain shift. It was thought that conversion from acute to subacute SDH was associated with the deterioration, and emergency hematoma evacuation was performed. Despite the surgery, neither clinical nor radiographical improvement occurred. The lack of improvement pointed to the presence of underlying IC, and a CT myelography revealed the dural sleeve of the right L2 nerve root as the source of the CSF leakage. An epidural blood patch therapy was performed on the 12th hospital day to seal the CSF leakage. The postprocedural course was uneventful, and the patient was discharged free of symptoms on the 20th hospital day. Spinal CSF leakage should be considered as a cause of delayed neurological deterioration in patients with traumatic acute SDH which exhibits conversion to subacute SDH.

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Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases

Cited by 23 publications

References 20 publications

Intracranial hypotension producing reversible coma: a systematic review, including three new cases

Intracranial hypotension producing reversible coma: a systematic review, including three new cases

Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient

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