Spontaneous Intracranial Hypotension Resulting in Coma: Case Report

Sayer, Faisal T.; Bodelsson, Mikael; Larsson, Elna‐Marie; Romner, Bertil

doi:10.1227/01.neu.0000219843.34356.ee

Cited by 46 publications

(38 citation statements)

References 26 publications

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“…In addition to headache, neck stiffness, dizziness, nausea, vomiting, blurred vision, change in hearing, and facial numbness and weakness are occasionally experienced. Severe complications such as subdural hemorrhage, cerebral vasoconstriction, intracranial venous thrombosis, seizure, stupor, and even death have been reported [2,3,4,5,6,7]. The syndrome became well recognized after the report of pachymeningeal gadolinium enhancement in the 1990s.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Lan²,

Chang³

et al. 2009

Eur Neurol

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Background and Purpose: Spontaneous intracranial hypotension (SIH) is an uncommon, but not rare, cause of headache. We analyzed a series of patients with SIH and attempted to establish a clinical procedure. Methods: We retrospectively reviewed 11 patients with SIH who were admitted between January 2004 and May 2007. Data recorded from patients included basic data, clinical symptoms, neurological imaging studies and treatment. Results: Orthostatic headache was the most common symptom, but there were still 2 patients without orthostatic headache. Diffuse pachymeningeal enhancement was the most common finding in brain MRI study and engorgement of the spinal epidural venous plexus was the most common finding in spinal MRI study. Eight of our patients received epidural blood patches in the lumbar area and 6 of these were symptom-free within 2 weeks. Two patients received spinal MRI immediately after administering the epidural blood patch, and this revealed that most of the blood had spread to the upper cervical area from the lumbar injection. Conclusion: A blind epidural blood patch from the lumbar area is an acceptable procedure even if the area of leakage is unknown. A reasonable clinical procedure for the patients of SIH may minimize the rate of repeat puncture.

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Section: Introductionmentioning

confidence: 99%

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Lan²,

Chang³

et al. 2009

Eur Neurol

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“…[5] Radiological features in cases with coma are subdural fluid collections/ hematoma, increasingly attenuated basilar cisterns, cerebral edema, diffuse enhancement of meninges and downward displacement of diencephalon and cerebellar tonsils. [6][7][8][9] According to Monro-Kellie hypothesis decreased cerebrospinal fluid pressure results in venous congestion resulting in enhancement of meninges or subdural collection which may cause herniation and mental decline. However, Savoiardo et al [10] reported increased diffusivity in diencephalo-mesencehalic structures by MRI in patients with brain sagging which is suggested to reflect vasogenic edema in those deep structures.…”

Section: Discussionmentioning

confidence: 99%

“…[2,7,8] Although evacuation of subdural collections provides transient improvements, this effect is not persistent. In few cases where EBP did not benefit epidural interventions like fibrin glue enjection [6] or saline infusion [3] reversed symptoms.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous intracranial hypotension presenting with coma: case report and review of the literature

Çelik

Tekatas

Albayram

et al. 2015

Agri

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JULY 2015 160 ÖzetSpontan intrakraniyal hipotansiyon (SİH) kafa travması ve lomber ponksiyon öyküsü olmaksızın ortastatik başağrısı, beyin omurilik sıvısı (BOS) basınç değişikliği ve sinir sistemi görüntülemesi ile karakterize bir tablodur. Altmış iki yaşında iki-dört hafta içinde ilerleyici kognitif yıkımla prezente olan erkek hastaya BOS basıncı ve sinir sistemi görüntülemesi sonuçlarına gore SİH tanısı konuldu ve konservatif olarak tedavisi yapıldı. Spontan intrakraniyal hipotansiyon oldukça nadir olarak koma ile de prezente olabilir.Anahtar Kelimeler: Koma; spontan intrakraniyal hipotansiyon. SummarySpontaneous intracranial hypotension is characterized by orthostatic headache in the absence of a history of head trauma or lumbar puncture, and diagnosis is confirmed by a specific cerebrospinal fluid pressure and neuroimaging findings. It rarely presents with coma. A 62-year-old man presented with progressive cognitive decline of 2 to 4 weeks' duration. He was diagnosed with spontaneous intracranial hypotension according to cerebrospinal fluid pressure and neuroimaging findings, and treated conservatively.

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“…15) SIH patients presenting with altered mental status or dementia often reported constant rather than orthostatic headache. 1,3,12,13,18) Such altered mental status may prevent the patients from describing the characteristics of their headache correctly. Another possibility is that SIH patients who present with altered mental status may have a larger dural hole compared with those who are neurologically intact.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,11) SIH patients with concomitant CSDH seem to complain of orthostatic headache less frequently than those without CSDH. 3,13,18) Therefore, the presence of CSDH may prevent orthostatic headache from developing by correcting the abnormally low intracranial pressure (ICP) or volume. 18) In the present case, the headache was not orthostatic, so we assumed incorrectly that SDH was unrelated to SIH and performed drainage which resulted in the complication of acute SDH.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension Presenting Without Orthostatic Headache Complicated by Acute Subdural Hematoma After Drainage for Chronic Subdural Hematoma-Case Report-

Kuramae

Inamasu

Nakagawa

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 28-year-old man presented with a case of spontaneous intracranial hypotension (SIH) manifesting as a bilateral chronic subdural hematoma (CSDH) without orthostatic headache. He developed lifethreatening acute SDH as a complication of CSDH drainage. Neurosurgeons should be aware that SIH patients do not always present with orthostatic headache. Brain magnetic resonance imaging with gadolinium may be recommended for young adults with non-traumatic CSDH before drainage to exclude SIH, even if they do not present with orthostatic headache.

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Spontaneous Intracranial Hypotension Resulting in Coma: Case Report

Abstract: This case report expands the presently known clinical spectrum of this uncommon and generally benign illness.

Cited by 46 publications

References 26 publications

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Spontaneous intracranial hypotension presenting with coma: case report and review of the literature

Spontaneous Intracranial Hypotension Presenting Without Orthostatic Headache Complicated by Acute Subdural Hematoma After Drainage for Chronic Subdural Hematoma-Case Report-

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