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Use of confirmatory imaging studies to illustrate adequate treatment of cerebrospinal fluid leak in spontaneous intracranial hypotension.

Abstract
Spontaneous intracranial hypotension (SIH) is a syndrome with serious neurological sequelae. As demonstrated by the following report, recurrent episodes of SIH can be difficult to diagnose when associated with other neurosurgical procedures, such as craniectomies. In this paper, the authors demonstrate SIH presenting as a subdural hematoma with recurrence of CSF leaks. Spontaneous intracranial hypotension was further complicated by paradoxical herniation following a craniectomy. Treatment of SIH necessitated multiple epidural blood patches for CSF leaks at different spinal levels and at different times. The efficacy of each epidural blood patch was confirmed with radionuclide imaging. Confirmation of effective blood patch placement may be useful for identifying patients at risk for a failed epidural blood patch or for patients whose neurological examination results have not fully improved.
AuthorsTimothy W Vogel, Brian J Dlouhy, Matthew A Howard 3rd
JournalJournal of neurosurgery (J Neurosurg) Vol. 113 Issue 5 Pg. 955-60 (Nov 2010) ISSN: 1933-0693 [Electronic] United States
PMID20524824 (Publication Type: Case Reports, Journal Article)
Topics
  • Aged
  • Blood Patch, Epidural
  • Craniotomy
  • Hematoma, Subdural (diagnostic imaging, etiology, therapy)
  • Humans
  • Intracranial Hypotension (complications, diagnostic imaging, therapy)
  • Male
  • Radionuclide Imaging
  • Recurrence
  • Subdural Effusion (diagnostic imaging, etiology, therapy)
  • Treatment Outcome

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