Spontaneous intracranial hypotension from intradural thoracic disc herniation

✓ Spontaneous intracranial hypotension (SIH) may result from occult leaks anywhere along the neuraxis. Although this syndrome has been recognized over the past 10 years in the neurology and radiology literature, the typical magnetic resonance (MR) imaging picture and clinical course are less well known to neurosurgeons. The authors describe the case of a patient with positional headache and MR imaging findings typical of SIH that resulted from an intradural disc herniation.

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Spontaneous intracranial hypotension due to thoracic disc herniation

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.3.0343 ◽

2002 ◽

Vol 96 (3) ◽

pp. 343-345 ◽

Cited By ~ 6

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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Intradural non-calcified thoracic disc herniation causing spontaneous intracranial hypotension: a case report

BMC Surgery ◽

10.1186/s12893-019-0527-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Michael Fiechter ◽

Alexander Ott ◽

Jürgen Beck ◽

Astrid Weyerbrock ◽

Jean-Yves Fournier

Keyword(s):

Case Report ◽

Disc Herniation ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Cervical bone spur presenting with spontaneous intracranial hypotension

Journal of Neurosurgery ◽

10.3171/jns.1998.89.3.0483 ◽

1998 ◽

Vol 89 (3) ◽

pp. 483-484 ◽

Cited By ~ 63

Author(s):

A. Giancarlo Vishteh ◽

Wouter I. Schievink ◽

Jonathan J. Baskin ◽

Volker K. H. Sonntag

Keyword(s):

Mr Imaging ◽

Intracranial Hypotension ◽

Cervical Spinal Cord ◽

Contrast Material ◽

Spontaneous Intracranial Hypotension ◽

Csf Leak ◽

Presumptive Diagnosis ◽

Content Type ◽

Hindbrain Herniation

✓ Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The exact cause of these CSF leaks often remains unknown. The authors treated a 32-year-old man with a unique cause of spontaneous intracranial hypotension. He suffered an excruciating headache that was exacerbated by his being in an upright position. The results of four-vessel cerebral angiography were negative; however, magnetic resonance (MR) imaging of the brain revealed pachymeningeal enhancement and hindbrain herniation. A presumptive diagnosis of spontaneous intracranial hypotension was made. Myelography revealed extrathecal contrast material ventral to the cervical spinal cord as well as an unusual midline bone spur at C5–6. The patient's symptoms did not resolve with the application of epidural blood patches, and he subsequently underwent an anterior approach to the C5–6 spur. After discectomy, a slender bone spur that had pierced the thecal sac was found. After its removal, the dural rent was closed using two interrupted prolene sutures. The patient was discharged home 2 days later. On follow up his symptoms had resolved, and on MR imaging the pachymeningeal enhancement had resolved and the cerebellar herniation had improved slightly.

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Traumatic intracranial hypotension due to a calcified thoracic disc herniation

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.229 ◽

2021 ◽

pp. 1-6

Author(s):

Sami Obaid ◽

Bilal Tarabay ◽

Daniel Shédid ◽

Sung-Joo Yuh

Keyword(s):

Disc Herniation ◽

Intracranial Hypotension ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Significance of Thoracic Disc Herniation Demonstrated by MR Imaging

Journal of Computer Assisted Tomography ◽

10.1097/00004728-198903000-00004 ◽

1989 ◽

Vol 13 (2) ◽

pp. 211-214 ◽

Cited By ~ 55

Author(s):

Michael P. Williams ◽

Graham R. Cherryman ◽

Janet E. Husband

Keyword(s):

Mr Imaging ◽

Disc Herniation ◽

Thoracic Disc Herniation ◽

Thoracic Disc

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Thoracic microendoscopic discectomy

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.1.0058 ◽

2004 ◽

Vol 1 (1) ◽

pp. 58-63 ◽

Cited By ~ 59

Author(s):

Mick J. Perez-Cruet ◽

Bong-Soo Kim ◽

Faheem Sandhu ◽

Dino Samartzis ◽

Richard G. Fessler

Keyword(s):

Minimally Invasive ◽

Disc Herniation ◽

Thoracic Disc Herniation ◽

Tubular Retractor ◽

Content Type ◽

Estimated Blood Loss ◽

Disc Herniations ◽

Microendoscopic Discectomy ◽

Thoracic Disc ◽

Fine Print

Object. Various approaches exist for the treatment of thoracic disc herniation. Anterior approaches facilitate ventral exposure but place the intrathoracic contents at risk. Posterolateral approaches require extensive muscle dissection that adds to the risk of postoperative morbidity. The authors have developed a novel posterolateral, minimally invasive thoracic microendoscopic discectomy (TMED) technique that provides an approach to the thoracic spine which is associated with less morbidity. Methods. Seven patients 23 to 54 years old with nine disc herniations underwent TMED. All lesions were soft lateral or midline thoracic disc herniations. Under fluoroscopic guidance with the patient positioned prone, the authors used a muscle dilation approach and the procedure was performed with endoscopic visualization through a tubular retractor. Based on a modified Prolo Scale, five patients experienced excellent results, one good, and one fair. No case required conversion to an open procedure. The mean operative time was 1.7 hours per level, and estimated blood loss was 111 ml per level. Hospital stays were short, and no complications occurred. Conclusions. The TMED is safe, effective, and provides a minimally invasive posterolateral alternative for treatment of thoracic disc herniation without the morbidity associated with traditional approaches.

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Disc herniation at T1–2

Journal of Neurosurgery ◽

10.3171/jns.1998.88.1.0148 ◽

1998 ◽

Vol 88 (1) ◽

pp. 148-150 ◽

Cited By ~ 40

Author(s):

Howard Morgan ◽

Christopher Abood

Keyword(s):

Disc Herniation ◽

Clinical Signs ◽

Cervical Disc ◽

Motor Deficit ◽

Thoracic Disc Herniation ◽

Content Type ◽

Disc Herniations ◽

Muscles Of The Hand ◽

Thoracic Disc ◽

Intrinsic Muscles

✓ In preparing this paper, the authors reviewed their experiences with four cases of T1–2 disc herniation as well as the medical literature on the subject. Intervertebral thoracic disc herniations are uncommon and high thoracic disc herniations are rare. In the upper third of the thoracic spine, T1–2 is the most common level for disc ruptures. Four cases of disc herniation at T1–2 that caused T-1 radiculopathy are reported in this paper. In reviewing the literature on thoracic disc herniation, the authors found 27 cases at the T1–2 level, 23 of which were lateral disc herniations that produced radiculopathy and four of which were central disc herniations that caused myelopathy. The clinical signs and symptoms of T-1 radiculopathy are similar to those of C-8 radiculopathy; however, distinguishing features can frequently be found on neurological examination. The T-1 radiculopathy usually involves weakness of the intrinsic muscles of the hand. The motor deficit of C-8 radiculopathy involves the intrinsic muscles of the hand and most of the flexors and extensors of the fingers and wrist. The T-1 radiculopathy may produce Horner's syndrome (oculosympathetic paralysis) and diminished sensation in the axilla, which are not found with C-8 radiculopathy. In clinical presentation as well as in treatment, the lateral T1–2 disc herniation resembles a cervical disc herniation, whereas the central T1–2 disc herniation displays the usual appearance of a thoracic disc herniation.

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A surgical approach through the pedicle to protruded thoracic discs

Journal of Neurosurgery ◽

10.3171/jns.1978.48.5.0768 ◽

1978 ◽

Vol 48 (5) ◽

pp. 768-772 ◽

Cited By ~ 176

Author(s):

Russel H. Patterson ◽

Ehud Arbit

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Disc Herniation ◽

Surgical Approach ◽

Cord Compression ◽

Thoracic Disc Herniation ◽

Midline Incision ◽

Content Type ◽

Thoracic Disc ◽

Fine Print

✓ Three cases of thoracic disc herniation presenting with signs of spinal cord compression are reported. The patients were operated on by an approach through a midline incision in which a pedicle is removed. Two patients were cured and one has improved.

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Spinal dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension

Journal of Neurosurgery ◽

10.3171/jns.1998.88.5.0912 ◽

1998 ◽

Vol 88 (5) ◽

pp. 912-918 ◽

Cited By ~ 74

Author(s):

N. Nicole Moayeri ◽

John W. Henson ◽

Pamela W. Schaefer ◽

Nicholas T. Zervas

Keyword(s):

Magnetic Resonance ◽

Mr Imaging ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Cerebrospinal Fluid Leak ◽

Clinical Findings ◽

Content Type ◽

Blood Patch ◽

Neoplastic Process ◽

Dural Enhancement

✓ This report offers a description of typical changes seen on gadolinium-enhanced magnetic resonance (MR) imaging of the entire spine that indicate spontaneous intracranial hypotension (SIH). To the authors' knowledge, this is the first report of its kind. They describe three cases of SIH that were accompanied by dural enhancement throughout the neuraxis on imaging, with the evolution of associated subdural and epidural fluid collections in the spine. Recognition of this disorder is important to be able to distinguish it from an infectious or neoplastic process in which surgical intervention might be warranted. Evaluation using gadolinium-enhanced cranial and spinal MR imaging in patients with postural headaches and an 111In-labeled cerebrospinal fluid leak study are discussed. Treatment with an epidural blood patch is shown to be particularly effective, with resolution of the radiological and clinical findings.

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