title: Emergent image-guided treatment of a large CSF leak to reverse "in-extremis" signs of intracranial hypotension.
abstract: 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.
authors.affiliation: Department of Radiology, The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Ill., USA.
authors.forename: A
authors.initials: A
authors.lastname: Aghaei Lasboo
authors.forename: A A
authors.initials: AA
authors.lastname: Lasboo
authors.forename: M C
authors.initials: MC
authors.lastname: Hurley
authors.forename: M T
authors.initials: MT
authors.lastname: Walker
authors.forename: D
authors.initials: D
authors.lastname: Surdell
authors.forename: J K
authors.initials: JK
authors.lastname: Song
authors.forename: J M
authors.initials: JM
authors.lastname: Rosenow
authors.forename: A
authors.initials: A
authors.lastname: Shaibani
mesh_terms: 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