Acute malignancy-related hydrocephalus uncovered after endoscopic manipulation: possible influence of gastrointestinal endoscopy on concurrent intracranial lesion.
A 78-year-old man underwent biliary stenting by means of endoscopy for obstructive jaundice due to common bile duct cancer. Despite uneventful operation, the patient remained comatose and began to hiccup and vomit with marked gastrointestinal gas retention. Neuroimaging studies disclosed obstructive hydrocephalus caused by a midbrain metastasis, probably from coexisting lung cancer. Ventricular peritoneal shunting restored consciousness and eliminated other gastrointestinal symptoms. This case suggests that gastrointestinal endoscopy may affect concurrent intracranial lesions, resulting in acute distress, presumably by transmission of pressure from the abdomen to a distant body compartment such as the intracranial space, or by endoscopy-related hypoventilation.
Zenda
Takahiro
T
Department of Internal Medicine, KKR Hokuriku Hospital, Japan. zenzen@kanazawa-shaho.com
Masunaga
Takaharu
T
Hayase
Hideo
H
D000208:Acute Disease; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D017809:Fatal Outcome; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed