title: Multiple simultaneous intracerebral hemorrhages following accidental massive lumbar cerebrospinal fluid drainage: case report and literature review.
abstract: Multiple simultaneous intracerebral hemorrhages (ICH) are uncommon. We report the case of an 80-year-old woman with previous diagnosis of normal pressure hydrocephalus and who was brought to our hospital with altered mental status and urinary incontinence. Medical history of hypertension, hematological disorders or severe head trauma was absent. Platelet count and coagulation profile were unremarkable. An initial head computed tomography (CT) showed sulcal enlargement and ventricular dilatation, but no evidence of ICH. A tap test indicated as a guide to case selection for shunt surgery accidentally resulted in cerebrospinal fluid (CSF) overdrainage. The patient presented sudden neurological deterioration, with sluggishly responsive pupils and generalized tonic-clonic seizures. A new head CT demonstrated multiple supra and infratentorial ICH. The patient became comatose and had a fatal course. Hence, CSF overdrainage may either cause or precipitate multiple simultaneous ICHs, affecting both the infratentorial and supratentorial regions.
authors.affiliation: Department of Neurology and Neurosurgery, Hospital Civil de Guadalajara Fray Antonio Alcalde, Mexico. jorusan@mexis.com
authors.forename: José L
authors.initials: JL
authors.lastname: Ruiz-Sandoval
authors.forename: Ariel
authors.initials: A
authors.lastname: Campos
authors.forename: Samuel
authors.initials: S
authors.lastname: Romero-Vargas
authors.forename: María I
authors.initials: MI
authors.lastname: Jiménez-Rodríguez
authors.forename: Erwin
authors.initials: E
authors.lastname: Chiquete
mesh_terms: D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000134:cerebrospinal fluid* / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications / Q000601:surgery; D019585:Intracranial Hypotension / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*