Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-26T09:44:23.570Z Has data issue: false hasContentIssue false
  • English
  • Français

Reversible Coma: A Rare Presentation of Spontaneous Intracranial Hypotension

Published online by Cambridge University Press:  02 December 2014

Jodi L. Kashmere ,
Michael J. Jacka ,
Derek Emery  and
Donald W. Gross
Jodi L. Kashmere
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Michael J. Jacka
Affiliation:
Department of Anesthesiology, Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada
Derek Emery
Affiliation:
Department of Radiology and Diagnostic Imaging, Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
Donald W. Gross
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Spontaneous intracranial hypotension (SIH) is a well-recognized neurologic disorder that typically presents with orthostatic headaches, low cerebral spinal fluid pressures and distinct abnormalities on magnetic resonance imaging.

Methods:

We present a case of a rare presentation of SIH.

Results:

A 49-year-old man presented with a two week history of orthostatic headaches that rapidly progressed to encephalopathy and coma, requiring intubation. Neuroimaging revealed abnormalities typical of SIH; diffusely enhancing pachymeninges, subdural fluid collections, and descent of the brain. Treatment with an epidural blood patch reversed his coma within minutes. Following a second blood patch, the patient became asymptomatic. No cerebral spinal leak could be identified on magnetic resonance imaging or on a nuclear medicine technetium cerebral spinal fluid flow study. At six month follow-up, he remained symptom free.

Conclusion:

The mechanism of coma in SIH is presumed to be compression of the diencephalon from downward displacement of the brain. Although it is very unusual for patients with SIH to present with coma, it is important to recognize since the coma may be reversible with epidural blood patches.

Type
Other
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 4 , November 2004 , pp. 565 - 568
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

1. Rando, TA, Fishman, RA. Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 1992; 42:481–487.Google Scholar
2. Waguri, N, Tomita, M, Hayatsu, K, Okamoto, K, Shimoji, K. Epidural blood patch for treatment of spontaneous intracranial hypotension. Acta Anaesthesiol 2002; 46: 747–750.Google Scholar
3. Szeinfield, M, Ihmeiden, H, Moser, MM, et al. Epidural blood patch: evolution of the volume and spread of blood injected into the epidural space. Anesthesiology 1986; 64: 820–822.CrossRefGoogle Scholar
4. Kroin, JS, Nagalla, SKS, Buvanendran, A, et al. The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a post dural puncture rat model. Anesth Analg 2002; 95(2): 423–429.CrossRefGoogle Scholar
5. Duff, PJ, Crosby, ET. The epidural blood patch. Resolving the controversies. Can J Anesth 1999; 46 (9): 878–886.Google Scholar
6. Sencakova, D, Mokri, B, McClelland, RL. The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 2001; 57: 1921–1923.CrossRefGoogle ScholarPubMed
7. Mokri, B. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebral spinal hypovolemia-evolution of a concept. Mayo Clin Proc 1999;74:1113–1123 Google Scholar
8. Spelle, L, Boulin, A, Tainturier, C, et al. Neuroimaging features of spontaneous intracranial hypotension. Neuroradiology 2001; 43: 622–627.CrossRefGoogle ScholarPubMed
9. Lin, WC, Lirng, JF, Fuh, JL, et al. MR findings in spontaneous intracranial hypotension. Acta Radiologica 2002; 43: 249–255.CrossRefGoogle ScholarPubMed
10. Pakiam, AS, Lee, C, Lang, AE. Intracranial hypotension with parkinsonism, ataxia, and bulbar weakness. Arch Neurol 1999; 56(7): 869–872.CrossRefGoogle ScholarPubMed
11. Hong, M, Shah, GV, Adams, KM, Turner, RS, Foster, NL. Spontaneous intracranial hypotension causing reversible frontotemporal dementia. Neurology 2002; 58: 1285–1287.CrossRefGoogle ScholarPubMed
12. Beck, CE, Rizk, NW, Kiger, LT, et al. Intracranial hypotension presenting with severe encephalopathy. J Neurosurg 1998; 89(3): 470–473.Google Scholar
13. Pleasure, SJ, Abosch, A, Friedman, J, et al. Spontaneous intracranial hypotension resulting in stupor caused by diencephalic compression. Neurology 1998; 50: 1854–1857.Google Scholar
14. Binder, DK, Dillon, W, Fishman, RA, Schmidt, MH. Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report. Neurosurgery 2002; 51: 830–837.CrossRefGoogle ScholarPubMed
15. Evans, RW, Mokri, B. Spontaneous intracranial hypotension resulting in coma. Headache 2002; 42:159–160.Google Scholar
16. Mokri, B. The Munro-Kelly hypothesis: applications in CSF volume depletion. Neurology 2001; 56: 1746–1748.CrossRefGoogle Scholar
17. Garcia-Albea, E, Cabrera, F, Tejeiro, J, et al. Delayed post-exertional headache, intracranial hypotension, and racket sports. J Neurol Neurosurg Psych 1992; 55:975.Google Scholar
18. Schoffer, KL, Benstead, TJ, Grant, I. Spontaneous intracranial hypotension in the absence of magnetic resonance imaging abnormalities. Can J Neurol Sci 2002; 29: 253–257.Google Scholar
19. Schievink, WI, Ebersold, MJ, Atkinson, JLD. Roller coaster headache due to spinal cerebrospinal fluid leak. Lancet 1996; 347: 1409.Google Scholar