Intracranial hypotension masquerading as nonconvulsive status epilepticus

2014 ◽  
Vol 120 (3) ◽  
pp. 624-627 ◽  
Author(s):  
Vishnumurthy Shushrutha Hedna ◽  
Abhay Kumar ◽  
Bayard Miller ◽  
Sharathchandra Bidari ◽  
Arash Salardini ◽  
...  

Intracranial hypotension (IH) has been a known entity in neurocritical care since 1938. Even though many cases are spontaneous, the incidence of intracranial hypotension in the neurocritical care setting is increasing by virtue of the increased number of neurosurgical interventions. Whether spontaneous or secondary in etiology, diagnosis of IH usually requires the presence of orthostatic symptoms, including headaches and nausea with low opening CSF pressure. However, typical clinical features in the appropriate clinical context and imaging, even with normal CSF pressure, can indicate IH. In the neurocritical care setting, challenges for accurate semiology include altered sensorium and reduced levels of responsiveness for which many etiologies may exist, including metabolic dysfunction, traumatic brain injury, IH, or nonconvulsive status epilepticus (NCSE). The authors describe 3 patients whose clinical picture and electroencephalography (EEG) findings initially suggested NCSE but who did not respond to treatment with antiepileptic drugs alone. Neuroimaging suggested IH, and subsequent treatment of IH successfully improved the patient's clinical status. To the authors' knowledge this paper is the first in the literature that reports a correlation of IH with electrographic findings similar to NCSE as cause and effect. The authors' hypothesis is that thalamocortical dysfunction causes EEG findings that appear to be similar to those in NCSE but that these conditions do not coexist. The EEG activity is not epileptogenic, and IH results in blocking network pathways producing thalamocortical dysfunction. The authors discuss the hypothesis and pathophysiology of these epileptiform changes in relation to IH.

Cephalalgia ◽  
1997 ◽  
Vol 17 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Y Sato ◽  
Y Honda ◽  
H Maruoka ◽  
Y Fujimatsu ◽  
K Oizumi

A 59-year-old man developed postural headache associated with a low CSF pressure. A CT scan revealed no abnormal findings and the orthostatic symptoms resolved without treatment 6 weeks after onset. He was diagnosed as having spontaneous intracranial hypotension (SIH) and remained symptom-free until he experienced recurrence of postural headache 9 months later. A lumbar puncture demonstrated low CSF pressure, and a CT scan revealed slit-like ventricles with narrowing of the sulci, Sylvian fissures, and infratentorial cisterns, in addition to bilateral subdural masses. After draining the hematomas, his symptoms resolved completely, and a follow-up CT scan was normal. We hypothesize that recurrent SIH in this case was due to small recurrent tears of a root sleeve. This case emphasizes the importance of follow-up of SIH for at least 9 months after resolution of symptoms.


Author(s):  
Christopher P. Robinson ◽  
Sara E. Hocker

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting longer than 5 minutes or recurrent seizure activity without return to baseline between events. Several classifications exist. The Neurocritical Care Society recommends a simplified classification in which SE is dichotomized as convulsive or nonconvulsive, with nonconvulsive status epilepticus further stratified as focal or generalized.


2021 ◽  
Vol 117 ◽  
pp. 107847
Author(s):  
Lucia Maltoni ◽  
Veronica Di Pisa ◽  
Valentina Marchiani ◽  
Silvia Bonetti ◽  
Duccio Maria Cordelli

Author(s):  
Jana Godau ◽  
Kaushal Bharad ◽  
Johannes Rösche ◽  
Gabor Nagy ◽  
Stefanie Kästner ◽  
...  

Epilepsia ◽  
2021 ◽  
Author(s):  
Simona Lattanzi ◽  
Giada Giovannini ◽  
Francesco Brigo ◽  
Niccolò Orlandi ◽  
Eugen Trinka ◽  
...  

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