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Published in: Acta Neurochirurgica 3/2018

01-03-2018 | Case Report - Spine

Compression of a giant pseudomeningocele causing transient anoxic seizures—a case report

Authors: Alhafidz Hamdan, A. Saxena, G. Rao, M. Ivanov

Published in: Acta Neurochirurgica | Issue 3/2018

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Abstract

Transient anoxic seizure upon application of pressure on a giant pseudomeningocele has never been reported in the literature; such abrupt changes in intracranial pressure due to large volume of cerebrospinal fluid (CSF) translocation, if left untreated may lead to permanent cerebral hypoxic injury and death. Here we describe a case of a 26-year-old woman who had undergone lumbar disc surgery in another unit few months ago and developed a large lump around her back. Any pressure on the lump resulted in headaches and at times episodes of seizures. Clinical examination revealed a very large fluid-filled lump consistent with a giant pseudomeningocele, confirmed by an MRI. A video EEG while applying pressure on the lump was recorded. The patient developed a typical seizure attack with a characteristic pattern of cerebral anoxia, and a paired ECG showed irregular rhythm with junctional and ventricular ectopic beats during the latter part of the attack, raising a suspicion of asystole. Upon relieving the pressure off the lump, the patient gradually regained consciousness with no permanent neurological deficit. We then discuss the pathophysiology of anoxic seizures and highlight the need to be vigilant in managing patients with such lesions in order to prevent permanent cerebral hypoxic injury and death.
Literature
1.
go back to reference Alfery DD, Shapiro HM, Gagnon RL (1980) Cardiac arrest following rapid drainage of cerebrospinal fluid in a patient with hydrocephalus. Anesthesiology 52(5):443–444CrossRefPubMed Alfery DD, Shapiro HM, Gagnon RL (1980) Cardiac arrest following rapid drainage of cerebrospinal fluid in a patient with hydrocephalus. Anesthesiology 52(5):443–444CrossRefPubMed
2.
go back to reference Bekavac I, Halloran JI (2003) Meningocele-induced positional syncope and retinal hemorrhage. AJNR Am J Neuroradiol 24(5):838–839PubMed Bekavac I, Halloran JI (2003) Meningocele-induced positional syncope and retinal hemorrhage. AJNR Am J Neuroradiol 24(5):838–839PubMed
4.
go back to reference Drummond JC, Ciacci JD, Lee RR (2014) Direct pressure on a pseudomeningocele resulting in intraoperative cerebral ischemia. Can J Anesth 61(7):656–659CrossRefPubMed Drummond JC, Ciacci JD, Lee RR (2014) Direct pressure on a pseudomeningocele resulting in intraoperative cerebral ischemia. Can J Anesth 61(7):656–659CrossRefPubMed
5.
go back to reference Fehnel CR, Razmara A, Feske SK (2014) Coma from wall suction-induced CSF leak complicating spinal surgery. BMJ Case Rep 12:bcr2014203801CrossRef Fehnel CR, Razmara A, Feske SK (2014) Coma from wall suction-induced CSF leak complicating spinal surgery. BMJ Case Rep 12:bcr2014203801CrossRef
6.
go back to reference Foley JA, Rao RD (2009) Traumatic lumbosacral pseudomeningocele associated with spinal fracture. Spine J 9(11):e5–e10CrossRefPubMed Foley JA, Rao RD (2009) Traumatic lumbosacral pseudomeningocele associated with spinal fracture. Spine J 9(11):e5–e10CrossRefPubMed
8.
go back to reference Kohler E, Prentice D (2010) Pseudomeningocele induced transient loss of consciousness in Marfan syndrome. Intern Med J 40(3):228–230CrossRefPubMed Kohler E, Prentice D (2010) Pseudomeningocele induced transient loss of consciousness in Marfan syndrome. Intern Med J 40(3):228–230CrossRefPubMed
9.
go back to reference Liu C, Cai HX, Fan SW, Liu YJ (2010) Postoperative pseudomeningocele in a 40-year-old man. Ir J Med Sci 180(4):925–927CrossRefPubMed Liu C, Cai HX, Fan SW, Liu YJ (2010) Postoperative pseudomeningocele in a 40-year-old man. Ir J Med Sci 180(4):925–927CrossRefPubMed
10.
go back to reference McNamara B, Ray J, Menon D, Boniface S (2003) Raised intracranial pressure and seizures in the neurological intensive care unit. Br J Anaesth 90(1):39–42CrossRefPubMed McNamara B, Ray J, Menon D, Boniface S (2003) Raised intracranial pressure and seizures in the neurological intensive care unit. Br J Anaesth 90(1):39–42CrossRefPubMed
11.
go back to reference Miller PR, Elder FW (1968) Meningeal pseudocysts (meningocele spurius) following laminectomy. Report of ten cases. J Bone Joint Surg Am 50(2):268–276CrossRefPubMed Miller PR, Elder FW (1968) Meningeal pseudocysts (meningocele spurius) following laminectomy. Report of ten cases. J Bone Joint Surg Am 50(2):268–276CrossRefPubMed
12.
go back to reference Moon HS, Lee SK, Kim SR, Kim SJ (2016) Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report. Korean J Anesthesiology 69(3):293–295CrossRef Moon HS, Lee SK, Kim SR, Kim SJ (2016) Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report. Korean J Anesthesiology 69(3):293–295CrossRef
13.
go back to reference Parpaley Y, Urbach H, Kovacs A, Klehr M, Kristof RA (2011) Pseudohypoxic brain swelling (postoperative intracranial hypotension-associated venous congestion) after spinal surgery: report of 2 cases. Neurosurgery 68(1):E277–E283CrossRefPubMed Parpaley Y, Urbach H, Kovacs A, Klehr M, Kristof RA (2011) Pseudohypoxic brain swelling (postoperative intracranial hypotension-associated venous congestion) after spinal surgery: report of 2 cases. Neurosurgery 68(1):E277–E283CrossRefPubMed
15.
go back to reference Stone JG, Bergmann LL, Takamori R, Donovan DJ (2015) Giant pseudomeningocele causing urinary obstruction in a patient with Marfan syndrome. J Neurosurg Spine 23(1):77–80CrossRefPubMed Stone JG, Bergmann LL, Takamori R, Donovan DJ (2015) Giant pseudomeningocele causing urinary obstruction in a patient with Marfan syndrome. J Neurosurg Spine 23(1):77–80CrossRefPubMed
16.
go back to reference Toshniwal GR, Bhagat H, Rath GP (2007) Bradycardia following negative pressure suction of subgaleal drain during craniotomy closure. Acta Neurochir 149(10):1077–1079CrossRefPubMed Toshniwal GR, Bhagat H, Rath GP (2007) Bradycardia following negative pressure suction of subgaleal drain during craniotomy closure. Acta Neurochir 149(10):1077–1079CrossRefPubMed
17.
go back to reference Van Lieshout JJ, Wieling W, Karemaker JM, Secher NH (2003) Syncope, cerebral perfusion, and oxygenation. J Appl Physiol 94(3):833–848CrossRefPubMed Van Lieshout JJ, Wieling W, Karemaker JM, Secher NH (2003) Syncope, cerebral perfusion, and oxygenation. J Appl Physiol 94(3):833–848CrossRefPubMed
18.
go back to reference Van Roost D, Thees C, Brenke C, Oppel F, Winkler PA, Schramm J (2003) Pseudohypoxic brain swelling: a newly defined complication after uneventful brain surgery, probably related to suction drainage. Neurosurgery 53(6):1315–1326CrossRefPubMed Van Roost D, Thees C, Brenke C, Oppel F, Winkler PA, Schramm J (2003) Pseudohypoxic brain swelling: a newly defined complication after uneventful brain surgery, probably related to suction drainage. Neurosurgery 53(6):1315–1326CrossRefPubMed
19.
Metadata
Title
Compression of a giant pseudomeningocele causing transient anoxic seizures—a case report
Authors
Alhafidz Hamdan
A. Saxena
G. Rao
M. Ivanov
Publication date
01-03-2018
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 3/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3446-z

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