Intrathecal saline infusion: an emergency procedure in a patient with spontaneous intracranial hypotension.
BACKGROUND
Spontaneous intracranial hypotension (SIH) is a neurologic condition with the prototypical symptom of orthostatic headache. We report a dramatic case of SIH with life-threatening bilateral hygroma and uncal herniation.


METHODS
Case report.


RESULTS
A 44-year-old male patient presenting with orthostatic headache and double vision was diagnosed with SIH. Diagnostic imaging showed meningeal enhancement and bilateral hygroma. A conservative treatment regime was initiated. The patient's condition rapidly deteriorated with progressive loss of consciousness. Cranial MRI showed beginning uncal herniation. As an emergency treatment measure, an intracranial pressure (ICP) probe was inserted and intrathecal lumbal saline infusion was initiated. This led to a stabilization of ICP and allowed further diagnostics and treatment.


CONCLUSIONS
Intrathecal lumbal saline infusion in combination with ICP monitoring can be a life-saving treatment option in unstable SIH patients.
Department of Neurology, University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. christian.sass@ukmuenster.de
Christian
C
Sass
Christoph
C
Kosinski
Patrick
P
Schmidt
Michael
M
Mull
Jörg
J
Schulz
Johannes
J
Schiefer
D000208:Acute Disease; D000328:Adult; D004632:Emergency Medical Services / Q000379:methods*; D006261:Headache / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006547:Hernia / Q000150:complications / Q000473:pathology / Q000628:therapy; D006801:Humans; D007278:Injections, Spinal; D019585:Intracranial Hypotension / Q000150:complications / Q000473:pathology / Q000628:therapy*; D018191:Lymphangioma, Cystic / Q000150:complications / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome
D012965:Sodium Chloride