Cervical bone spur presenting with spontaneous intracranial hypotension. Case report.
Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The exact cause of these CSF leaks often remains unknown. The authors treated a 32-year-old man with a unique cause of spontaneous intracranial hypotension. He suffered an excruciating headache that was exacerbated by his being in an upright position. The results of four-vessel cerebral angiography were negative; however, magnetic resonance (MR) imaging of the brain revealed pachymeningeal enhancement and hindbrain herniation. A presumptive diagnosis of spontaneous intracranial hypotension was made. Myelography revealed extrathecal contrast material ventral to the cervical spinal cord as well as an unusual midline bone spur at C5-6. The patient's symptoms did not resolve with the application of epidural blood patches, and he subsequently underwent an anterior approach to the C5-6 spur. After discectomy, a slender bone spur that had pierced the thecal sac was found. After its removal, the dural rent was closed using two interrupted prolene sutures. The patient was discharged home 2 days later. On follow up his symptoms had resolved, and on MR imaging the pachymeningeal enhancement had resolved and the cerebellar herniation had improved slightly.
Vishteh
A G
AG
Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, USA.
Schievink
W I
WI
Baskin
J J
JJ
Sonntag
V K
VK
D000328:Adult; D017217:Blood Patch, Epidural; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D017586:Diskectomy; D004388:Dura Mater / Q000601:surgery; D004677:Encephalocele / Q000209:etiology; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D007089:Image Enhancement; D019585:Intracranial Hypotension / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000473:pathology; D009192:Myelography; D011126:Polypropylenes; D011187:Posture; D012249:Rhombencephalon / Q000473:pathology; D013128:Spinal Osteophytosis / Q000150:complications* / Q000601:surgery; D013536:Suture Techniques; D013537:Sutures
D003287:Contrast Media; D011126:Polypropylenes