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Intracranial hypotension

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https://www.readbyqxmd.com/read/28079571/spontaneous-intracranial-hypotension-with-site-of-leak-detected-only-after-111in-dtpa-cisternogram
#1
Sana Parsian, Manuela C Matesan, Sachin Shivaji Kumbhar, David H Lewis
A 54-year-old man with a 3-week history of orthostatic headache and acute on chronic subdural hematoma presented with imaging findings suggestive of spontaneous intracranial hypotension. Three myelograms were negative for leak, and nontargeted epidural blood patches did not result in symptom relief. A cerebrospinal fluid leak study using In-DTPA with SPECT/CT demonstrated a focal area of asymmetric activity at the left C2 nerve root. A left C2 root tie-off, targeted epidural blood patch, and Dura seal glue resulted in resolution of patient symptomatology highlighting the importance of fused SPECT/CT images in detection of an occult cerebral spinal fluid leak...
January 10, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28057591/surgical-management-of-spontaneous-spinal-cerebrospinal-fluid-epidural-fistula
#2
Declan G Siedler, Imogen M Ibbett, Nova B Thani
BACKGROUND: Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid (CSF) fistula is a rare condition which can have serious sequelae. Early diagnosis and treatment can be challenging. CASE DESCRIPTION: We present a case of a 17-year-old man who presented with a history of sudden onset, postural headaches, associated with upper thoracic back pain. Magnetic Resonance Imaging (MRI) demonstrated a thoracic extradural fluid collection and slumping of the brain within the posterior fossa...
January 2, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28043956/factors-predicting-response-to-the-first-epidural-blood-patch-in-spontaneous-intracranial-hypotension
#3
Jr-Wei Wu, Shu-Shya Hseu, Jong-Ling Fuh, Jiing-Feng Lirng, Yen-Feng Wang, Wei-Ta Chen, Shih-Pin Chen, Shuu-Jiun Wang
Spontaneous intracranial hypotension results from cerebrospinal fluid leakage. Currently, the treatment of choice for spontaneous intracranial hypotension is the epidural blood patch, which has a variable response rate and no clear outcome predictors. This study aimed to identify predictors for response rate of a first targeted epidural blood patch in patients with spontaneous intracranial hypotension. We reviewed cases of patients with spontaneous intracranial hypotension who received targeted epidural blood patch at our hospital between 1 January 2007 and 1 July 2014...
January 2, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28036062/an-unusual-case-of-post-traumatic-headache-complicated-by-intracranial-hypotension
#4
Sara Siavoshi, Carrie Dougherty, Jessica Ailani, Kaustubh Yadwadkar, Frank Berkowitz
We present a case of post-traumatic headache complicated by intracranial hypotension resulting in an acquired Chiari malformation and myelopathy with syringomyelia. This constellation of findings suggest a possible series of events that started with a traumatic cerebral spinal fluid (CSF) leak, followed by descent of the cerebellar tonsils and disruption of CSF circulation that caused spinal cord swelling and syrinx. This unusual presentation of post-traumatic headache highlights the varying presentations and the potential sequelae of intracranial hypotension...
December 29, 2016: Brain Sciences
https://www.readbyqxmd.com/read/28017759/the-monro-kellie-doctrine-in-action-posterior-reversible-leukoencephalopathy-syndrome-pres-due-to-intracranial-hypotension-from-lumbo-peritoneal-shunt-placement
#5
Ioannis Karakis, Audrey H Nuccio, Jordan P Amadio, Arthur J Fountain
BACKGROUND: Posterior reversible leukoencephalopathy syndrome (PRES) is linked to various etiologies, foremost systemic hypertension. Its association with intracranial hypotension (IH), a potential sequela of various neurosurgical procedures, is under-recognized. We report a case of lumbo-peritoneal shunt induced IH resulting in PRES with the goal to increase awareness, and elaborate on the potential biological mechanism, based on the Monro-Kellie hypothesis. CASE DESCRIPTION: A 26-year-old woman with acquired immunodeficiency syndrome and epilepsy was admitted for recurrent cryptococcal meningitis and breakthrough seizures...
December 22, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/28006941/early-changes-of-brain-perfusion-after-subarachnoid-hemorrhage-the-effect-of-sodium-nitroprusside
#6
M Kolar, K Nohejlova, J Mares, J Pachl
Causes of early hypoperfusion after subarachnoid hemorrhage (SAH) include intracranial hypertension as well as vasoconstriction. The aim of the study was to assess the effect of intracerebroventricular (ICV) administration of sodium nitroprusside (SNP) on early hypoperfusion after SAH. Male Wistar rats (220-240 g) were used, SAH group received 250 microl of fresh autologous arterial blood into the prechiasmatic cistern; sham-operated animals received 250 microl of isotonic solution. Therapeutic intervention: ICV administration of 10 microg SNP; 5 microl 5 % glucose (SNP vehicle) and untreated control...
December 22, 2016: Physiological Research
https://www.readbyqxmd.com/read/27994919/frequency-of-nerve-root-sleeve-cysts-in-autosomal-dominant-polycystic-kidney-disease
#7
Murat Aşık, Fatih Tufan, Timur Selçuk Akpınar, Nilgül Akalın, Elvan Ceyhan, Necmeddin Tunç, Zehra Işık Hasıloğlu, Mehmet Rıza Altıparmak, Tevfik Ecder, Sait Albayram
BACKGROUND: There is sporadic data about the occurrence of spinal meningeal cysts in patients with autosomal dominant polycystic kidney disease (ADPKD). We suggest that there is a relationship with the frequency and size of spinal meningeal cysts and headache, intracranial aneurysms, and cerebrospinal fluid leakage in patients with ADPKD. AIM: To investigate the relationship with spinal meningeal cyst, cerebrospinal fluid leakage, and headache in patients with ADPKD...
November 2016: Balkan Medical Journal
https://www.readbyqxmd.com/read/27943273/granulomatosis-with-polyangiitis-associated-hypertrophic-pachymeningitis-mimicking-spontaneous-intracranial-hypotension-a-case-report
#8
Young Hee Jung, Mi Ji Lee, Chungbin Lee, Jihoon Cha, Chin-Sang Chung
BACKGROUND: Dural enhancement is a characteristic finding in both spontaneous intracranial hypotension and hypertrophic pachymeningitis. Positional headache is the most important feature that distinguishes the two diseases. We report a patient with granulomatosis with polyangiitis (formerly Wegener's granulomatosis) who initially manifested like spontaneous intracranial hypotension. CASE PRESENTATION: We report here the case of a 63-year old man who presented with severe positional headache...
December 10, 2016: Headache
https://www.readbyqxmd.com/read/27913508/risk-stratification-and-management-of-acute-pulmonary-embolism
#9
Cecilia Becattini, Giancarlo Agnelli
The clinical management of patients with acute pulmonary embolism is rapidly changing over the years. The widening spectrum of clinical management strategies for these patients requires effective tools for risk stratification. Patients at low risk for death could be candidates for home treatment or early discharge. Clinical models with high negative predictive value have been validated that could be used to select patients at low risk for death. In a major study and in several meta-analyses, thrombolysis in hemodynamically stable patients was associated with unacceptably high risk for major bleeding complications or intracranial hemorrhage...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27910096/de-novo-migraine-with-aura-after-surgical-repair-of-aortic-coarctation
#10
Yuji Kato, Takeshi Hayashi, Toshiki Kobayashi, Ayumu Masuoka, Tetsuya Abe, Takahiro Hasebe, Norio Tanahashi, Masaki Takao
Coarctation of the aorta (CoA) is reported to be associated with an increased risk for migraine. We describe here the case of a 13-year-old female patient who presented migraine with aura after surgical repair of CoA with a stent. As possible reasons for her condition, we postulate host responses to stent placement and/or disturbed cerebral autoregulation related to intracranial hypertension before the surgical repair and hypotension afterward, leading to hypoperfusion. This case demonstrates that de novo migraine with aura can occur after surgical repair of CoA and should be recognized as a potential complication...
December 2, 2016: Headache
https://www.readbyqxmd.com/read/27906941/epidural-blood-patch-for-the-treatment-of-spontaneous-and-iatrogenic-orthostatic-headache
#11
Yun So, Jung Min Park, Pil-Moo Lee, Cho Long Kim, Cheolhan Lee, Jae Hun Kim
BACKGROUND: The cerebrospinal fluid (CSF) leakage could be happened spontaneously or related to the procedures such as spinal anesthesia, epidural anesthesia, CSF tapping, intrathecal chemotherapy or other spinal procedures. The leakage of CSF leads to intracranial hypotension of which distinguishing clinical feature is orthostatic headache. The epidural blood patch is a gold-standard treatment for intracranial hypotension-related orthostatic headaches. OBJECTIVE: We conducted this study to compare the efficacy and number of epidural blood patches for spontaneous and iatrogenic orthostatic headaches...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27905574/reply-to-spontaneous-intracranial-hypotension-and-its-association-with-movement-disorders
#12
COMMENT
Richard Salazar
In Response To: Onder H. Spontaneous intracranial hypotension and its association with movement disorders? Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D84B31NS Original Article: Salazar R. Spontaneous intracranial hypotension associated with kinetic tremor and ataxia. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8HQ3ZN5.
2016: Tremor and Other Hyperkinetic Movements
https://www.readbyqxmd.com/read/27897276/spontaneous-intracranial-hypotension-and-its-association-with-movement-disorders
#13
Halil Onder
In Response To: Salazar R. Spontaneous intracranial hypotension associated with kinetic tremor and ataxia. Tremor Other Hyperkinet Mov. 2016; 6. doi: 10.7916/D8HQ3ZN5.
2016: Tremor and Other Hyperkinetic Movements
https://www.readbyqxmd.com/read/27894887/ultrasound-tissue-pulsatility-imaging-suggests-impairment-in-global-brain-pulsatility-and-small-vessels-in-elderly-patients-with-orthostatic-hypotension
#14
Julie Biogeau, Thomas Desmidt, Paul-Armand Dujardin, Redouane Ternifi, Charlotte Eudo, Emilie Vierron, Jean-Pierre Remenieras, Frédéric Patat, Vincent Camus, Thierry Constans
BACKGROUND: Orthostatic hypotension (OH) is highly prevalent in the elderly, and this population can be exposed to serious complications, including falls and cognitive disorders, as well as overall mortality. However, the pathophysiology of OH is still poorly understood, and innovative methods of cerebral blood flow (CBF) assessment have been required to accurately investigate cerebrovascular reactivity in OH. OBJECTIVES: We want to compare brain tissue pulsatility (BTP) changes during an orthostatic challenge in elderly patients over 80 with and without OH...
November 25, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27861828/postural-headaches-due-to-cerebrospinal-fluid-leakage-through-subarachnoid-pleural-fistula-a-case-report
#15
Sheng-Feng Lin, Hsing-Yu Weng
BACKGROUND: Postural headaches are commonly associated with spontaneous intracranial hypotension and cerebrospinal fluid (CSF) leakage from the spine. A subarachnoid-pleural fistula (SPF) is a very rare and serious type of CSF fistula that has mostly been reported following traumatic causes. CASE REPORT: Here, the case of a 36-year-old woman who suffered from postural headaches after chiropractic manipulation of her neck was reported. Brain and spinal magnetic resonance (MR) imaging showed brain sagging, a C7-T1 dural defect, and overt CSF leakage...
November 10, 2016: Headache
https://www.readbyqxmd.com/read/27861178/use-of-prothrombin-complex-concentrate-for-warfarin-reversal-before-the-performance-of-an-epidural-blood-patch-in-a-patient-with-cortical-vein-thrombosis-and-subdural-hematoma-a-case-report
#16
Kallol Chaudhuri, Cooper W Phillips, Swapna Chaudhuri, John Wasnick
Compared to conventional therapy, several studies with prothrombin complex concentrate (PCC) have recently demonstrated its superior efficacy in rapidly replacing vitamin K-dependent factors for patients with life-threatening hemorrhage. We present a novel use of PCC in a patient with intracranial hypotension, who had received warfarin for treatment of cortical vein thrombosis. However, after anticoagulation, she proceeded to develop bilateral subdural hematomas with descent of cerebellar tonsils. Given the possibility of an occult dural puncture during labor analgesia, an epidural blood patch was performed after administration of PCC and normalization of coagulation parameters, with prompt improvement of the patient's headache...
January 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/27857927/a-fatal-adverse-effect-of-barbiturate-coma-therapy-dyskalemia
#17
Hyun Mook Kwon, Jin Wook Baek, Sang Pyung Lee, Jae Ik Cho
The management guideline for traumatic brain injury (TBI) recommends high-dose barbiturate therapy to control increased intracranial pressure refractory to other therapeutic options. High-dose barbiturate therapy, however, may cause many severe side effects; the commonly recognized ones include hypotension, immunosuppression, hepatic dysfunction, renal dysfunction, and prolonged decrease of cortical activity. Meanwhile, dyskalemia remains relatively uncommon. In this study, we report the case of a hypokalemic patient with severe rebound hyperkalemia, which occurred as a result of barbiturate coma therapy administered for TBI treatment...
October 2016: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/27854087/spontaneous-intracranial-hypotension-complicated-by-malignancyinduced-disseminated-intravascular-coagulation-a-case-report
#18
Hung-Yi Wu, Shu-Shya Hseu, Shih-Pin Chen, Jiing-Feng Lirng, Yen-Feng Wang, Shuu-Jiun Wang, Jong-Ling Fuh
PURPOSE: Spontaneous intracranial hypotension (SIH) is a rare type of headache. The association of SIH with malignancy and disseminated intravascular coagulation (DIC) has not previously been reported. CASE REPORT: A 60-year-old woman had orthostatic headache for more than one month before admission. MRI of brain showed diffuse pachymeningeal enhancement with bilateral subdural hematoma. MR myelography revealed epidural fluid collection and possible CSF leakage at the level of C5 to C6...
September 15, 2016: Acta Neurologica Taiwanica
https://www.readbyqxmd.com/read/27848124/reversible-cerebral-vasoconstriction-syndrome-and-posterior-reversible-encephalopathy-syndrome-associated-with-intracranial-hypotension
#19
Katharina Feil, Robert Forbrig, Franziska S Thaler, Julian Conrad, Suzette Heck, Franziska Dorn, Hans-Walter Pfister, Andreas Straube
BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES) are both rare disorders. The pathophysiology of both diseases is not yet fully understood. METHODS: We report the unique case of a 19-year-old comatose woman who was brought to the ER after a series of generalized tonic-clonic seizures 6 days post peridural anesthesia for cesarean section. Vital signs and initial laboratory testing including urine analysis and drug screening were unremarkable...
November 15, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27832615/-changes-in-spinal-mri-findings-for-epidural-fluid-collection-in-the-treatment-of-intracranial-hypotension
#20
Norimitsu Nakagawa
We have experienced 30 cases of intracranial hypotension in the last three years. Spinal MRI was performed in all cases, and 27 patients demonstrated epidural fluid collection(EFC). Of these 30 patients, 6 were treated conservatively with bed rest and hydration, and 24 were treated with epidural blood patch(EBP). Twenty-two patients were cured, 4 were improved significantly, and 4 were improved partially. We examined spinal MR images of 22 patients after 3 months of treatment. The EFC wasn't visible in 11 cases;however, residual EFC was found in the 11 remaining cases...
November 2016: No Shinkei Geka. Neurological Surgery
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