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The domino effect of acephalgic spontaneous intracranial hypotension

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Abstract

Spontaneous intracranial hypotension results from a spinal CSF leak and usually presents with orthostatic headache, although acephalgic presentations have anecdotally been reported. The underlying low CSF volume, rarely, leads to serious complications such as cerebral venous thrombosis and coma. We report a patient presenting with cerebral venous thrombosis secondary to acephalgic spontaneous intracranial hypotension. An epidural blood patch was performed; nonetheless, the patient intracracal condition deteriorated to coma and neuroimages showed a deep brain swelling with midbrain distortion, subsequently complicated by intracranial pontine hemorrhage.

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Fig. 1
Fig. 2

Abbreviations

SIH:

spontaneous intracranial hypotension

CSF:

cerebrospinal fluid

CVT:

cerebral venous thrombosis

CT:

computed tomography

MRI:

magnetic resonance imaging

EBP:

epidural blood patch

SSS:

sagittal superior sinus

GCS:

Glasgow Coma Scale

ICH::

intracranial hemorrhage

DSA:

digital subtraction angiography (DSA)

SS:

straight sinus

vG:

vein of Galen

References

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Acknowledgments

We thank Cecilia Baroncini for English language editing.

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Author notes

  1. Umberto Pensato and Fabrizio Giammello contributed equally to this work.

Authors and Affiliations

  1. Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy

    Umberto Pensato, Tommaso Baldini & Giorgia Arnone

  2. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Fabrizio Giammello

  3. Department of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Largo Nigrisoli 2, 40133, Bologna, Italy

    Anna Zaniboni, Laura Piccolo, Giorgia Arnone, Mauro Gentile & Andrea Zini

  4. Neuroradiology Unit, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Luigi Cirillo

  5. DIMES, Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy

    Luigi Cirillo

  6. Neuroradiology Unit, Maggiore Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Luigi Simonetti & Salvatore Isceri

Authors
  1. Umberto Pensato
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  2. Fabrizio Giammello
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  3. Tommaso Baldini
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  4. Anna Zaniboni
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  5. Laura Piccolo
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  6. Giorgia Arnone
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  7. Mauro Gentile
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  8. Luigi Cirillo
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  9. Luigi Simonetti
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  10. Salvatore Isceri
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  11. Andrea Zini
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Contributions

UP and FG conceptualized the study and wrote the original draft. TB, AZ1, LP, GA, MG, LG, LS, SI, and AZ reviewed and critiqued the manuscript.

Corresponding author

Correspondence to Andrea Zini.

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Conflict of interest

The authors declare that there is no conflict of interest.

Ethics approval

The paper does not report on primary research. All data analyzed were collected as part of routine diagnosis and treatment.

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Clinical highlights

• Spontaneous intracranial hypotension (SIH) rarely presents sine headache.

• SIH may result in complications as cerebral venous thrombosis (CVT).

• CVT without common risk factors should be screened for asymptomatic SIH.

• Severe brain sagging may cause deep brain swelling and coma.

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Pensato, U., Giammello, F., Baldini, T. et al. The domino effect of acephalgic spontaneous intracranial hypotension. Neurol Sci 42, 309–312 (2021). https://doi.org/10.1007/s10072-020-04755-1

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  • DOI: https://doi.org/10.1007/s10072-020-04755-1

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