Emergent image-guided treatment of a large CSF leak to reverse "in-extremis" signs of intracranial hypotension.
We report the use of an emergent, targeted fibrin spinal epidural blood patch with subarachnoid saline infusion to rapidly reverse "in-extremis" clinical and imaging signs of posterior-fossa coning brought about by acute-on-chronic intracranial hypotension, itself consequent to a cervicothoracic CSF leak. Treatment resulted in a dramatic recovery and eventual discharge with return to normal lifestyle and occupation. The clinical and imaging danger signs are reviewed; fibrin patch technique and potential pitfalls in postprocedure management are analyzed.
Aghaei Lasboo
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A
Department of Radiology, The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Ill., USA.
Lasboo
A A
AA
Hurley
M C
MC
Walker
M T
MT
Surdell
D
D
Song
J K
JK
Rosenow
J M
JM
Shaibani
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A
D017217:Blood Patch, Epidural; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D003937:Diagnosis, Differential; D004630:Emergencies; D004677:Encephalocele / Q000175:diagnosis / Q000601:surgery; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D009460:Neurologic Examination; D038361:Neuronavigation; D012008:Recurrence; D012086:Reoperation; D013353:Subdural Effusion / Q000175:diagnosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed