Orthostatic Headache After Suboccipital Craniectomy Without CSF Leak: Two Case Reports

2018 ◽  
Vol 58 (8) ◽  
pp. 1238-1243 ◽  
Author(s):  
Monique M. Montenegro ◽  
Jeremy K. Cutsforth-Gregory
Keyword(s):  
Case Reports ◽  
Orthostatic Headache ◽  
Csf Leak ◽  
Suboccipital Craniectomy

scholarly journals Intracranial hypotension and hypertension: reversible Chiari malformation due to dynamic cerebrospinal fluid abnormalities in Gorham-Stout disease. Case report

2018 ◽  
Vol 22 (5) ◽  
pp. 508-512 ◽  
Author(s):  
Shoko Yoshimoto ◽  
Keisuke Takai ◽  
Koichi Takahashi ◽  
Toshio Yasui ◽  
Makoto Taniguchi
Keyword(s):  
Intracranial Hypotension ◽  
Chiari Malformation ◽  
Neurological Status ◽  
Orthostatic Headache ◽  
Csf Leak ◽  
Disease Case ◽  
Blood Patch ◽  
Visual Acuity Loss ◽  
Suboccipital Decompression ◽  
Fractures Of The Femur

Gorham-Stout disease (GSD) is an intractable disease characterized by massive osteolysis caused by abnormal lymphangiogenesis in bone. In rare cases of GSD, CSF abnormalities develop. The authors present the case of a 19-year-old woman with GSD presenting with orthostatic headache due to intracranial hypotension (5 cm H2O). The clinical course of this case was very unusual. Orthostatic headache was associated with a CSF leak from the thigh after pathological fractures of the femur and pelvis. The chronic CSF leak led to acquired Chiari malformation (CM) with syringomyelia. After an epidural blood patch, her neurological status improved; however, after the complete arrest of the CSF leak from the thigh, she presented with severe nonpostural headache and progressive visual acuity loss with optic papilledema. A ventriculoperitoneal shunt was placed to treat intracranial hypertension (50 cm H2O). Headache improved and optic papilledema decreased after shunt surgery. This case shows that dynamic CSF abnormalities may lead to reversible CM in patients with GSD. Sealing a CSF leak rather than performing suboccipital decompression is recommended for acquired CM resulting from a CSF leak.

Transclival Approach for Resection of a Pontine Cavernous Malformation: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E413-E413
Author(s):  
Dennis London ◽  
Seth Lieberman ◽  
Omar Tanweer ◽  
Donato Pacione
Keyword(s):  
Cavernous Malformation ◽  
Case Reports ◽  
Abducens Nerve ◽  
Petrous Bone ◽  
Fat Graft ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Cavernous Malformations ◽  
Lumbar Drain ◽  
Magnetic Resonance Imaging Mri

Abstract Cerebral cavernous malformations are common vascular anomalies consisting of a cluster of capillaries without intervening brain tissue.1 A variety of approaches for resection have been undertaken,2 and a handful of case reports have described the endoscopic, endonasal, transclival approach.3 We present a case of a 51-yr-old woman with lupus and hepatitis B-associated cirrhosis who presented with diplopia, dysphagia, and ataxia. She had a left abducens nerve palsy and magnetic resonance imaging (MRI) showed a left pontine cavernous malformation. After a repeat hemorrhage, she consented to surgical resection. The lesion appeared to come to the medial pontine pial surface. Tractography indicated a rightward displacement of the left corticospinal tract. Therefore, an endoscopic, transnasal, transclival approach was chosen. A lumbar drain was placed preoperatively. The clivus and ventral petrous bone were drilled using the vidian canal to help identify the anterior genu of the petrous carotid artery. The clival dura was opened, revealing the abducens nerve exiting the ventral pons. The cavernoma was visible on the surface lateral to the nerve. It was removed using blunt dissection and the remaining cavity inspected. The skull base was reconstructed using an abdominal dermal-fat graft and Alloderm covered by a nasoseptal flap. Postoperatively she had transient swallowing difficulty. The lumbar drain was kept open for 5 d. Cerebrospinal fluid (CSF) leak was ruled out using an intrathecal fluorescein injection. She was discharged home, but presented 2 wk postoperatively with aseptic meningitis, which was treated supportively. Postoperative imaging did not show residual cavernoma.

Orthostatic headache without CSF leak

Neurology ◽  
2008 ◽  
Vol 71 (23) ◽  
pp. 1902-1906 ◽  
Author(s):  
A. N. Leep Hunderfund ◽  
B. Mokri
Keyword(s):  
Orthostatic Headache ◽  
Csf Leak

scholarly journals Cryptococcal Meningitis in a HIV Seronegative Patient: A Rare Complication of Cerebrospinal Fluid Leak Detected with a New Cisternographic Technique

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Chukwunonso Chime ◽  
Charbel Ishak ◽  
Kishore Kumar ◽  
Muhammad Kamal ◽  
Srinivasan Krishna ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Case Reports ◽  
Rare Complication ◽  
Cerebrospinal Fluid Leak ◽  
Immunocompetent Patient ◽  
Adverse Outcomes ◽  
Csf Leak ◽  
Predisposing Factor ◽  
Identifiable Risk Factor ◽  
Seronegative Patient

Immune deficiency is usually the underlying predisposing factor for cryptococcal meningitis, though there have been case reports of immunocompetent patients presenting with same. The portal of entry for Cryptococcus neoformans is the respiratory tract, and by hematogenous spread, it causes systemic symptoms. The presence of CSF leak is described to have predisposed our immunocompetent patient to infection by this organism possibly through direct spread. The gold standard for diagnosing CSF leak is by cisternography. In this case, we added a technique where nasal gauze is inserted during the procedure and scanned afterwards for dye, thus increasing the confidence of diagnosis of CSF leak through the nares. Prompt diagnosis and treatment is key to prevent adverse outcomes, and we propose that in patients with cryptococcal meningitis without any identifiable risk factor, evaluation for CSF leak should be considered especially with history of head trauma.

Cerebellar hemorrhage presenting as orthostatic headache: Two case reports

Neurology ◽  
1999 ◽  
Vol 53 (8) ◽  
pp. 1887-1887 ◽  
Author(s):  
W.-T. Chen ◽  
J.-L. Fuh ◽  
S.-R. Lu ◽  
S.-J. Wang
Keyword(s):  
Case Reports ◽  
Orthostatic Headache ◽  
Cerebellar Hemorrhage

scholarly journals Cabergoline-Induced Pneumocephalus Following Treatment for Giant Invasive Macroprolactinoma Presenting With Spontaneous Cerebrospinal Fluid Rhinorrhea

2018 ◽  
Vol 11 ◽  
pp. 117955141875864 ◽  
Author(s):  
Souha S Elabd ◽  
Maswood M Ahmad ◽  
Sameer Q Qetab ◽  
Mussa Hussain Almalki
Keyword(s):  
Cerebrospinal Fluid ◽  
Medical Treatment ◽  
Case Reports ◽  
Rare Complication ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Surgical Interventions ◽  
Tension Pneumocephalus ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Uncommon Presentation

Cerebrospinal fluid (CSF) rhinorrhea is rarely reported as the first presenting feature of giant invasive macroprolactinomas. Cerebrospinal fluid rhinorrhea is usually reported as a complication of trauma, neurosurgical, and skull-based procedures (such as pituitary surgery or radiations), and less frequently after medical treatment with dopamine agonists (DAs) for macroprolactinomas. This phenomenon results from fistula creation that communicates between the subarachnoid space and the nasal cavity. Meanwhile, pneumocephalus is another well-recognized complication after transsphenoidal surgery for pituitary macroadenomas. This entity may present with nausea, vomiting, headache, dizziness, and more seriously with seizures and/or a decreased level of consciousness if tension pneumocephalus develops. Case reports about the occurrence of spontaneous pneumocephalus after medical treatment with DAs without prior surgical interventions are scarce in the literature. Our index case is a young man who was recently diagnosed with a giant invasive prolactin-secreting pituitary macroadenoma with skull base destruction. A few months before this diagnosis, he presented with spontaneous CSF rhinorrhea with no history of previous medical or surgical treatment. In this case report, we report an uncommon presentation for giant invasive macroprolactinoma with a CSF leak treated with cabergoline that was subsequently complicated by meningitis and pneumocephalus. This is a very rare complication of cabergoline therapy, which occurred approximately 1 month after treatment initiation.

Orthostatic Headache Syndrome with Csf Leak Secondary To Bony Pathology of the Cervical Spine

Cephalalgia ◽  
2002 ◽  
Vol 22 (6) ◽  
pp. 439-443 ◽  
Author(s):  
EJ Eross ◽  
DW Dodick ◽  
KD Nelson
Keyword(s):  
Cervical Spine ◽  
Lumbar Puncture ◽  
Symptomatic Relief ◽  
Low Pressure ◽  
Orthostatic Headache ◽  
Csf Leak ◽  
Headache Syndrome ◽  
Csf Leaks

The syndrome of orthostatic (low pressure) headaches is well described and most commonly occurs following deliberate violation of the dura (e.g. lumbar puncture). This syndrome can also occur spontaneously and results from the leakage of CSF. We describe three patients who suffered from spontaneous CSF leaks secondary to bony pathology of the cervical spine, and propose that this may be a more common aetiology than originally thought. Often these patients are difficult to manage medically, and surgery may be necessary for symptomatic relief.

Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak

Neurology ◽  
2013 ◽  
Vol 81 (20) ◽  
pp. 1789-1792 ◽  
Author(s):  
A. Starling ◽  
F. Hernandez ◽  
J. M. Hoxworth ◽  
T. Trentman ◽  
R. Halker ◽  
...  
Keyword(s):  
Orthostatic Headache ◽  
Csf Leak ◽  
Ct Myelography

A novel technique of multiple-site epidural blood patch administration for the treatment of cerebrospinal fluid hypovolemia

2012 ◽  
Vol 116 (5) ◽  
pp. 1049-1053 ◽  
Author(s):  
Tatsuya Ohtonari ◽  
Shinzo Ota ◽  
Nobuharu Nishihara ◽  
Taisei Ota ◽  
Yasue Tanaka ◽  
...  
Keyword(s):  
Epidural Space ◽  
Subdural Hematoma ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Chronic Subdural Hematoma ◽  
Orthostatic Headache ◽  
Csf Leak ◽  
Multiple Site ◽  
Intravenous Catheter ◽  
Blood Patch

Object An epidural blood patch (EBP) is a widely accepted standard procedure to treat CSF hypovolemia, especially when the epidural CSF leak is detected by spinal MRI or CT myelography (CTM). In quite a few cases, however, the leaked CSF is spread over a large area along the spinal epidural space, making it difficult for the surgeon to clearly identify the true leakage points. In such cases, autologous blood can be infused at multiple spinal levels with multiple entries. In this paper, the authors have devised a new multiple-site EBP method with a single lumbar entry point by way of using an intravenous catheter as a slidable device for continuous infusion. In this report, they introduce this new, single-entry, continuous multiple-site EBP administration technique and report some of the results that they have obtained. Methods An EBP was applied via an epidural catheter in 5 patients with spontaneous CSF hypovolemia (3 men and 2 women; mean age 47.2 years, range 34–65 years). The detection of an epidural CSF leak was based on MRI and/or CTM findings. In all cases, however, the leakage sites could not be identified clearly. The main symptoms of these patients were recurrent spontaneous chronic subdural hematoma with orthostatic headache (3 patients) and orthostatic headache only (2 patients). All patients underwent surgery in the prone position on an angiography table, and biplane fluoroscopy was used for accurate manipulation. After administration of a local anesthetic, the authors inserted a 4-Fr short sheath (which is standard in angiography) through the lumbar interlaminar window and placed it in the dorsal epidural space. They then introduced a 4.2-Fr straight catheter through the sheath and navigated it upward along a 35-gauge guidewire whose tip was moved upward beyond the cranial end of the detected CSF leakage. Blood was obtained from each patient from a previously secured venous entry on the forearm, and it was injected slowly into the epidural catheter. Each time, the authors tried to infuse as much autologous blood as possible into the epidural space, while moving the catheter gradually in the caudal direction in response to the patient's expression of pain. Results In all 3 cases of chronic subdural hematoma, its recurrence was prevented. In 1 patient, the orthostatic headache disappeared completely, and it was relieved in the other 4 patients. Conclusions An efficient treatment option for CSF hypovolemia is provided by the new application method of EBP with the aid of an intravenous catheter as a slidable device, which enables infusion of a sufficient amount of autologous blood into multiple epidural areas with a single lumbar entry point.

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