Intracranial hypotension presenting with severe encephalopathy

1998 ◽  
Vol 89 (3) ◽  
pp. 470-473 ◽  
Author(s):  
Carter E. Beck ◽  
Norman W. Rizk ◽  
Lydia T. Kiger ◽  
David Spencer ◽  
Laureen Hill ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Hypotension ◽  
Neurological Diseases ◽  
Clinical Spectrum ◽  
Severe Illness ◽  
Laboratory Findings ◽  
Postural Headache ◽  
Content Type ◽  
Cerebral Structures ◽  
Fine Print

✓ A patient with severe and protracted symptoms from intracranial hypotension is described. The patient's presentation was marked by diffuse encephalopathy and profound depression of consciousness. This case report expands the presently known clinical spectrum of this uncommon and generally benign illness. The clinical and laboratory findings typically observed in the syndrome of intracranial hypotension are outlined. The pathophysiological mechanisms of the phenomenon are briefly discussed. Intracranial hypotension is a potentially severe illness with specific treatments that are distinct from the treatment of most neurological diseases. Three cardinal features—postural headache, pachymeningitis, and descent of midline cerebral structures—should prompt the diagnosis.

Matrix metalloproteinase—9 concentration after spontaneous intracerebral hemorrhage

2003 ◽  
Vol 99 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Sònia Abilleira ◽  
Joan Montaner ◽  
Carlos A. Molina ◽  
Jasone Monasterio ◽  
José Castillo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurological Diseases ◽  
Neurological Status ◽  
Acute Stage ◽  
Ct Scans ◽  
Enzyme Linked Immunosorbent Assay ◽  
Content Type ◽  
Blood Brain Barrier Disruption ◽  
Brain Barrier Disruption ◽  
Fine Print

Object. Matrix metalloproteinases (MMPs) are overexpressed in the presence of some neurological diseases in which blood—brain barrier disruption exists. The authors investigated the MMP-9 concentration in patients after acute intracerebral hemorrhage (ICH) and its relation to perihematomal edema (PHE). Methods. Concentrations of MMP-9 and related proteins were determined in plasma by performing an enzyme-linked immunosorbent assay of samples drawn after hospital admission (< 24 hours after stroke) from 57 patients with ICH. The diagnosis of ICH was made on the basis of findings on computerized tomography (CT) scans. The volumes of ICH and PHE were measured on baseline and follow-up CT scans at the same time that the patient's neurological status was assessed using the Canadian Stroke Scale and the Glasgow Coma Scale. Increased expression of MMP-9 was found among patients with ICH. In cases of deep ICH, MMP-9 was significantly associated with PHE volume (r = 0.53; p = 0.01) and neurological worsening (237.4 compared with 111.3 ng/ml MMP-9; p = 0.04). A logistic regression model focusing on the study of absolute PHE volume showed ICH volume as an independent predictor (odds ratio [OR] 3.37; 95% confidence interval [CI] 1.1–10.3; p = 0.03). A second analysis of relative PHE volume (absolute PHE volume/ICH volume) in patients with deep ICH demonstrated that the only factor related to it was MMP-9 concentration (OR 11.6; 95% CI 1.5–89.1; p = 0.018). Conclusions. Expression of MMP-9 is raised after acute spontaneous ICH. Among patients with deep ICH this increase is associated with PHE and the development of neurological worsening within the acute stage.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

1998 ◽  
Vol 88 (2) ◽  
pp. 237-242 ◽  
Author(s):  
John L. D. Atkinson ◽  
Brian G. Weinshenker ◽  
Gary M. Miller ◽  
David G. Piepgras ◽  
Bahram Mokri
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari I Malformation ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Intracranial Hypotension Syndrome ◽  
Csf Leakage ◽  
Chiari I ◽  
Fine Print

Object. Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. Methods. The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. Conclusions. This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

Automobile accidents caused by unsuspected neurological disease

1973 ◽  
Vol 38 (5) ◽  
pp. 581-583 ◽  
Author(s):  
James R. Keane
Keyword(s):  
Neurological Disease ◽  
Neurological Diseases ◽  
Artery Aneurysm ◽  
The Other ◽  
Automobile Accidents ◽  
Content Type ◽  
Cerebral Trauma ◽  
Left Posterior ◽  
Posterior Communicating Artery Aneurysm ◽  
Fine Print

✓ Two patients admitted as cerebral trauma cases following single-car automobile accidents were found to have previously-unsuspected, surgically-treatable neurological diseases that undoubtedly caused the accidents. A left posterior communicating artery aneurysm was clipped in one patient and a right frontal lobe abscess aspirated in the other, with excellent results in both patients.

Gas in a spinal extradural cyst

1989 ◽  
Vol 70 (3) ◽  
pp. 486-488 ◽  
Author(s):  
Rakesh Kumar ◽  
Charles G. H. West ◽  
James E. Gillespie
Keyword(s):  
Case Report ◽  
Review Of The Literature ◽  
Content Type ◽  
Anatomic Distribution ◽  
Extradural Cyst ◽  
Extradural Space ◽  
Fine Print

✓ This case report describes a patient with sciatica resulting from lumbar root compression by a gas-containing cyst in the extradural space. Removal of the cyst provided prompt relief. The origin and anatomic distribution of gas collections in the spine are considered based on a review of the literature.

Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension

2001 ◽  
Vol 94 (4) ◽  
pp. 642-645 ◽  
Author(s):  
Chikanori Inenaga ◽  
Tokutaro Tanaka ◽  
Naoki Sakai ◽  
Shigeru Nishizawa
Keyword(s):  
Computerized Tomography ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Upright Position ◽  
Breath Holding ◽  
Content Type ◽  
Radionuclide Cisternography ◽  
Csf Leakage ◽  
Upper Cervical ◽  
Fine Print

✓ The authors present the case of a 55-year-old man suffering from intractable spontaneous intracranial hypotension, in whom conservative treatment with 19 weeks of bed rest was not effective. In this period the patient twice underwent surgery for bilateral chronic subdural hematoma, a complication of spontaneous intracranial hypotension. Conventional radionuclide cisternography, magnetic resonance imaging, and computerized tomography myelography did not demonstrate cerebrospinal fluid (CSF) leakage. Repeated radionuclide cisternography with the patient in an upright position revealed leakage of the tracer at upper cervical levels. Computerized tomography myelography with breath holding also showed CSF leakage of the contrast medium bilaterally at upper cervical levels. The patient underwent surgery, and bilateral C-2 and C-3 spinal nerve root pouches were sealed off from the subarachnoid space with oxidized cellulose cotton and fibrin glue. Epiarachnoid spaces around the root sleeves were also sealed to ensure complete resolution of the CSF leakage. After the surgery, the patient was completely free of the disease. In the case of intractable persistent spontaneous intracranial hypotension, surgical treatment is preferable to long-term conservative management. To identify CSF leakage, radionuclide cisternography with the patient in the upright position is useful. When obvious leakage is encountered, surgical sealing of the lesion should be performed via a subarachnoid approach.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Intramedullary cervical spinal cord abscess

1982 ◽  
Vol 57 (2) ◽  
pp. 270-273 ◽  
Author(s):  
J. Bob Blacklock ◽  
Terry W. Hood ◽  
Robert E. Maxwell
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Critical Factors ◽  
Laboratory Findings ◽  
Content Type ◽  
Prompt Diagnosis ◽  
Fine Print

✓ A case of spontaneous intramedullary cervical spinal cord abscess is presented. The clinical and laboratory findings in cases of spinal cord abscess vary. Prompt diagnosis and drainage are stressed as critical factors in effectively managing the disease.

scholarly journals Transforaminal Blood Patch for the Treatment of Chronic Headache from Intracranial Hypotension: A Case Report and Review

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Kirk Bowden ◽  
Adam Wuollet ◽  
Amol Patwardhan ◽  
Theodore J. Price ◽  
John Lawall ◽  
...  
Keyword(s):  
Case Report ◽  
Conservative Treatment ◽  
Successful Treatment ◽  
Intracranial Hypotension ◽  
Chronic Headache ◽  
Fluoroscopic Guidance ◽  
Postural Headache ◽  
Published Report ◽  
Blood Patch

This case report describes the successful treatment of chronic headache from intracranial hypotension with bilateral transforaminal (TF) lumbar epidural blood patches (EBPs). The patient is a 65-year-old male with chronic postural headaches. He had not had a headache-free day in more than 13 years. Conservative treatment and several interlaminar epidural blood patches were previously unsuccessful. A transforaminal EBP was performed under fluoroscopic guidance. Resolution of the headache occurred within 5 minutes of the procedure. After three months without a headache the patient had a return of the postural headache. A second transforaminal EBP was performed again with almost immediate resolution. The patient remains headache-free almost six months from the time of first TF blood patch. This is the first published report of the use of transforaminal epidural blood patches for the successful treatment of a headache lasting longer than 3 months.

The role of intracranial hypotension in neonatal intraventricular hemorrhage

1983 ◽  
Vol 58 (2) ◽  
pp. 204-209 ◽  
Author(s):  
E. Scott Conner ◽  
Antonio V. Lorenzo ◽  
Keasley Welch ◽  
Brent Dorval
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Intracranial Hypotension ◽  
Intraventricular Hemorrhage ◽  
Rabbit Model ◽  
Germinal Matrix ◽  
Content Type ◽  
Ventricular Hemorrhage ◽  
Fine Print

✓ Most preterm infants develop transient intracranial hypotension, which reaches its lowest level on the 2nd day of life. This corresponds to the time when most neonatal intraventricular hemorrhage (IVH) occurs. In order to test the hypothesis that intracranial hypotension may have an etiological role in the development of IVH in premature infants, the authors induced intracranial hypotension in the preterm rabbit by the intraperitoneal injection of glycerol. The rabbit model is well suited for this study because this animal is at risk of developing spontaneous germinal matrix and ventricular hemorrhage. Compared to control littermates, the glycerol-treated animals exhibited a greater than 3.5-fold incidence of germinal matrix and intraventricular hemorrhage.

Spontaneous intracranial hypotension due to thoracic disc herniation

2002 ◽  
Vol 96 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Stuart C. A. Winter ◽  
Nicholas F. Maartens ◽  
Philip Anslow ◽  
Peter J. Teddy
Keyword(s):  
Disc Herniation ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Herniated Disc ◽  
Subdural Effusion ◽  
Thoracic Disc Herniation ◽  
Content Type ◽  
Blood Patch ◽  
Thoracic Disc ◽  
Fine Print

✓ Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause. The patient was treated with an epidural blood patch and burr hole drainage of the subdural effusion on two occasions. Postoperatively the headache resolved and there was no neurological deficit. Thoracic disc herniation may be a cause of spontaneous intracranial hypotension.

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