Coma from wall suction-induced CSF leak complicating spinal surgery.

Abstract

A 72-year-old woman was admitted for elective L4/L5 laminectomy. The operative procedure was extradural, and a Jackson-Pratt (JP) drain was placed in the tissue bed and set to wall suction during skin closure. During closure, the patient developed a 15 s period of asystole. The patient was haemodynamically stable, but was comatose for 3 days postoperatively. Cardiac enzymes and EEG were unrevealing. Head CT showed traces of subarachnoid haemorrhage and signs suggestive of cerebral anoxia. JP drain at the incision produced 170-210 mL/day of fluid, positive for β-2 transferrin, indicating cerebrospinal fluid (CSF). The patient fully returned to baseline on hospital day 10. MRI on hospital day 8 normalised. The reversible coma and radiographic findings were most consistent with acute intracranial hypotension relating to acute loss of CSF. Because radiographic findings can mimic hypoxic-ischaemic injury, acute intracranial hypotension should be considered in the differential diagnosis of postoperative coma after cranial or spinal surgery.

• Authors: Corey R Fehnel, Ali Razmara, Steven K Feske
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2014 (Mar 12 2014) ISSN: 1757-790X [Electronic] England
• PMID: 24623547 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Cerebrospinal Fluid Leak
• Cerebrospinal Fluid Rhinorrhea (complications, diagnostic imaging, pathology)
• Coma (diagnostic imaging, etiology, pathology)
• Female
• Humans
• Hypoxia, Brain (complications, diagnostic imaging, pathology)
• Intracranial Hypotension (complications, diagnostic imaging, pathology)
• Laminectomy
• Magnetic Resonance Imaging
• Postoperative Complications
• Subarachnoid Hemorrhage (complications, diagnostic imaging, pathology)
• Suction
• Tomography, X-Ray Computed