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Neurocritical Care
Published in: Neurocritical Care 1/2013

01-08-2013 | Practical Pearl

Intrathecal Saline Infusion: An Emergency Procedure in a Patient with Spontaneous Intracranial Hypotension

Authors: Christian Sass, Christoph Kosinski, Patrick Schmidt, Michael Mull, Jörg Schulz, Johannes Schiefer

Published in: Neurocritical Care | Issue 1/2013

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Abstract

Background

Spontaneous intracranial hypotension (SIH) is a neurologic condition with the prototypical symptom of orthostatic headache. We report a dramatic case of SIH with life-threatening bilateral hygroma and uncal herniation.

Methods

Case report.

Results

A 44-year-old male patient presenting with orthostatic headache and double vision was diagnosed with SIH. Diagnostic imaging showed meningeal enhancement and bilateral hygroma. A conservative treatment regime was initiated. The patient’s condition rapidly deteriorated with progressive loss of consciousness. Cranial MRI showed beginning uncal herniation. As an emergency treatment measure, an intracranial pressure (ICP) probe was inserted and intrathecal lumbal saline infusion was initiated. This led to a stabilization of ICP and allowed further diagnostics and treatment.

Conclusion

Intrathecal lumbal saline infusion in combination with ICP monitoring can be a life-saving treatment option in unstable SIH patients.
Literature
1.
Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295:2286–96.PubMedCrossRef
2.
3.
Schievink WI, Maya MM. Cerebral venous thrombosis in spontaneous intracranial hypotension. Headache. 2008;48:1511–9.PubMedCrossRef
4.
Berroir S, Grabli D, Héran F, Bakouche P, Bousser MG. Cerebral sinus venous thrombosis in two patients with spontaneous intracranial hypotension. Cerebrovasc Dis. 2004;17:9–12.PubMedCrossRef
5.
Binder DK, Dillon WP, Fishman RA, Schmidt MH. Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report. Neurosurgery. 2002;51:830–6. discussion 836–7.PubMed
6.
Akkawi N, Locatelli P, Borroni B, et al. A complicated case of intracranial hypotension: diagnostic and management strategies. Neurol Sci. 2006;27:63–6.PubMedCrossRef
7.
Sayao AL, Heran MK, Chapman K, Redekop G, Foti D. Intracranial hypotension causing reversible frontotemporal dementia and coma. Can J Neurol Sci. 2009;36:252–6.PubMed
8.
Cho KI, Moon HS, Jeon HJ, Park K, Kong DS. Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch. Neurology. 2011;76:1139–44.PubMedCrossRef
9.
Gladstone JP, Nelson K, Patel N, Dodick DW. Spontaneous CSF leak treated with percutaneous CT-guided fibrin glue. Neurology. 2005;64:1818–9.PubMedCrossRef
10.
Schievink WI, Georganos SA, Maya MM, Moser FG, Bladyka M. Anaphylactic reactions to fibrin sealant injection for spontaneous spinal CSF leaks. Neurology. 2008;70:885–7.PubMedCrossRef
11.
Yoon SH, Chung YS, Yoon BW, Kim JE, Paek SH, Kim DG. Clinical experiences with spontaneous intracranial hypotension: a proposal of a diagnostic approach and treatment. Clin Neurol Neurosurg. 2011;113:373–9.PubMedCrossRef
12.
Loya JJ, Mindea SA, Yu H, Venkatasubramanian C, Chang SD, Burns TC. Intracranial hypotension producing reversible coma: a systematic review, including three new cases. J Neurosurg. 2012;117(3):615–28.PubMedCrossRef
13.
Tan K, Venketasubramanian N, Hwang CY, Lim CC. My headache does not get better when I lie down: spontaneous intracranial hypotension complicated by venous thrombosis. Headache. 2008;48:149–52.PubMedCrossRef
14.
Rouaud T, Lallement F, Choui R, Madigand M. Treatment of spontaneous intracranial hypotension by epidural saline infusion. Rev Neurol (Paris). 2009;165:201–5.CrossRef
15.
Couch JR. Spontaneous intracranial hypotension: the syndrome and its complications. Curr Treat Options Neurol. 2008;10:3–11.PubMedCrossRef
16.
Schievink WI, Maya MM, Tourje J. False localizing sign of C1–2 cerebrospinal fluid leak in spontaneous intracranial hypotension. J Neurosurg. 2004;100:639–44.PubMedCrossRef
Metadata
Title
Intrathecal Saline Infusion: An Emergency Procedure in a Patient with Spontaneous Intracranial Hypotension
Authors
Christian Sass
Christoph Kosinski
Patrick Schmidt
Michael Mull
Jörg Schulz
Johannes Schiefer
Publication date
01-08-2013
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2013
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-012-9783-0

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