hypotension intracraneal

Primary intracranial pressure disorders include idiopathic intracranial hypertension and spontaneous intracranial hypotension. Remarkable advances have been made in the diagnosis and treatment of these 2entities in recent years. Therefore, the Spanish Society of Neurology's Headache Study Group (GECSEN) deemed it necessary to prepare this consensus statement, including diagnostic and therapeutic algorithms to facilitate and improve the management of these disorders in clinical practice. This document was created by a committee of experts belonging to GECSEN, and is based on a systematic review of the literature, incorporating the experience of the participants, and establishes practical recommendations with levels of evidence and grades of recommendation...

Traumatic brain injury (TBI) is an important health and social problem. The mechanism of damage of this entity could be divided into two phases: (1) a primary acute injury because of the traumatic event; and (2) a secondary injury due to the hypotension and hypoxia generated by the previous lesion, which leads to ischemia and necrosis of neural cells. Cerebral edema is one of the most important prognosis markers observed in TBI. In the early stages of TBI, the cerebrospinal fluid compensates the cerebral edema...

Remote intracranial hemorrhage (ICH) is a rare but dreaded complication after spinal surgery. The physiopathology of this phenomenon is closely related to a loss of cerebrospinal fluid (CSF) after an incidental durotomy during spine surgery. The most common remote ICH location is cerebellar, but few articles report intraventricular hemorrhage. Its clinic is associated with cerebral hypotension due to decreased CSF, mainly headache, dysarthria, hemiparesis, an impaired level of awareness and seizures. The diagnosis of remote ICH after a non-cranial surgery can be a challenge to anesthesiologists, this pathology should be suspected face an immediate neurological deterioration after anesthetic awakening...

Intracraneal hypotension headache is a well known syndrome in neurosurgery practice. In most cases cerebrospinal fluid leaks are caused by medical interventions, such as lumbar puncture, peridural anesthesia and surgical interventions on the spine. Clinical symptoms tipically show orthostatic headache that resolves in supine position, and other symptoms like neck tightness, vertigo and diplopia. RMI diagnostic confirms paquimeningeal enhancement and subdural hygromas. Conservative treatment usually includes bed resting, hydratation and administration of caffeine or glucocorticoids, resolving spontaneously in one to four months...

Intracranial hemorrhage during pregnancy is a rare complication, and it results in a high perinatal mortality rate. We recently encountered 2 cases of intracranial hemorrhage during pregnancy. They underwent cesarean section under general anesthesia. Anesthetic management is difficult because we must avoid hemodynamic change and increasing intracranial pressure, and we have difficult airway management. It is also very difficult to prepare for the prevention before the onset because it develops suddenly, and quick action is important...

INTRODUCTION: It is now recognized that most, if not all, cases of spontaneous intracraneal hypotension result from spontaneous cerebrospinal fluid (CSF) leaks. The exact cause of spontaneous leak often remains unclear. However, two factors are typically considered: trivial trauma and weakness of the dural sac. CLINICAL CASE: A 61-year-old woman came with a one week history of orthostatic headache. The neurologic examination and funduscopy were normal. Brain contrast- enhanced magnetic resonance imaging (MRI) showed subdural fluid collections and diffuse pachymeningeal enhancement...

Intracranial dural arteriovenous fistulas (DAVF) are arteriovenous communications within the duramater, which seem to be pathophysiologically related to a venous sinus thrombosis. DAVF may require invasive treatment, although rarely spontaneous occlusion has been reported. The present case is a 48-year-old male with a diagnosed type III DAVF of the right lateral sinus. Complete endovascular embolization was not possible to perform, so he was considered a candidate for surgical treatment. During perioperative management, under general anesthesia, the intraoperative arteriographyc monitoritation showed a spontaneous closure of the DAVF after induced controlled hypotension, resulting in complete cure...

We report a patient with spontaneous intracranial hypotension who developed severe neck pain after hard exercise. The pain was worse when the patient was standing and was relieved when he lay flat. Radionuclide cisternography demonstrated a central spinal fluid leak in the thoracic region of the spine. The syndrome resolved with conservative treatment. Although the most typical feature of spontaneous intracranial hypotension is postural headache, unnecessary testing can be avoided if we suspect this entity in the presence of cervical pain that worsens when the patient is upright and disappears or improves when he or she is lying down...

Two cases of carotid sinus syndrome with peculiar clinical and nosological characteristics are presented. The clinical symptoms were characterized by syncope with bradicardia and hypotension, which occurred contemporarily or independently of each other. The most valuable medical therapy to prevent or got over the syncopal attacks has proved to be one associating the sympathicomimetic drugs (high dosage dopamine, particularly on demande pacemaker. Complete decrease of symptoms following was obtained only after surgical treatment: denervation of carotid sinus in one case, intracranical section of the glosspharyngeal nerve and of the two vagal termination nearer to IX in the other case...