title: Intracranial hypotension caused by leakage of cerebrospinal fluid from the thecal sac after lumboperitoneal shunt placement. Case report.
abstract: The authors describe a newly recognized complication of lumboperitoneal (LP) shunt placement, namely, intracranial hypotension from leakage of cerebrospinal fluid (CSF) through a defect in the lumbar dura created by the shunt catheter. They report on a 47-year-old obese woman with idiopathic intracranial hypertension who underwent routine placement of an LP shunt. Following surgery, her headache became worse. Two radionuclide shunt studies showed no anterograde tracer flow, suggesting either obstruction or a leak. After shunt reservoir manometry indicated low pressure, spinal magnetic resonance (MR) imaging was performed. The MR images revealed a CSF leak from the lumbar thecal sac. A computed tomography (CT) myelogram, performed by injection into the shunt reservoir, confirmed the presence of a leak by showing extravasation of contrast agent into the epidural space. The patient was treated by application of a CT-guided blood patch at the leak site. Catheter-associated CSF leak is an unusual cause of intracranial hypotension that can occur following LP shunt placement. This case report outlines the clinical features of this condition, documents the neuroradiological findings, and demonstrates successful treatment with a blood patch.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, California 94143-0730, USA.
authors.forename: Yaping Joyce
authors.initials: YJ
authors.lastname: Liao
authors.forename: William P
authors.initials: WP
authors.lastname: Dillon
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: Chin
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Horton
mesh_terms: D017217:Blood Patch, Epidural; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010211:Papilledema; D010537:Peritoneum; D011183:Postoperative Complications; D011559:Pseudotumor Cerebri / Q000175:diagnosis* / Q000601:surgery*; D013353:Subdural Effusion / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D013667:Technetium
chemical_list: D013667:Technetium