When does too little pressure become too much? A case of spontaneous intracranial hypotension presenting with acute loss of consciousness.
Cerebrospinal fluid effusion
Essential intracranial hypotension
Neurosurgery
Spontaneous subdural surgical management
Journal
Surgical neurology international
ISSN: 2229-5097
Titre abrégé: Surg Neurol Int
Pays: United States
ID NLM: 101535836
Informations de publication
Date de publication:
2023
2023
Historique:
received:
04
04
2023
accepted:
29
08
2023
medline:
9
10
2023
pubmed:
9
10
2023
entrez:
9
10
2023
Statut:
epublish
Résumé
We present a unique case of spontaneous intracranial hypotension (SIH) presenting with acute collapse and loss of consciousness. The affected patient suffered an abrupt decline in level of consciousness several weeks after initial diagnosis. The patient was urgently transferred to a specialist neurosurgical unit. Imaging showed bilateral subdural fluid collections with significant associated local mass effect. The treating team faced a clinical conundrum with a lack of clarity as to whether this sudden deterioration was secondary to the local pressure effect on brainstem traction from reduced intracranial pressure. A decision was made to proceed with urgent burr-hole decompression of the bilateral subdural fluid collections. After a protracted, complex postoperative course, the patient recovered to full functional independence. To the author's knowledge, this is the first case in literature describing successful surgical management of SIH, with bilateral burr-hole evacuation to relieve the paradoxical mass effect of bilateral subdural fluid collections.
Sections du résumé
Background
UNASSIGNED
We present a unique case of spontaneous intracranial hypotension (SIH) presenting with acute collapse and loss of consciousness.
Case Description
UNASSIGNED
The affected patient suffered an abrupt decline in level of consciousness several weeks after initial diagnosis. The patient was urgently transferred to a specialist neurosurgical unit. Imaging showed bilateral subdural fluid collections with significant associated local mass effect. The treating team faced a clinical conundrum with a lack of clarity as to whether this sudden deterioration was secondary to the local pressure effect on brainstem traction from reduced intracranial pressure. A decision was made to proceed with urgent burr-hole decompression of the bilateral subdural fluid collections.
Conclusion
UNASSIGNED
After a protracted, complex postoperative course, the patient recovered to full functional independence. To the author's knowledge, this is the first case in literature describing successful surgical management of SIH, with bilateral burr-hole evacuation to relieve the paradoxical mass effect of bilateral subdural fluid collections.
Identifiants
pubmed: 37810301
doi: 10.25259/SNI_293_2023
pii: 10.25259/SNI_293_2023
pmc: PMC10559507
doi:
Types de publication
Case Reports
Langues
eng
Pagination
338Informations de copyright
Copyright: © 2023 Surgical Neurology International.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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