title: Coma from wall suction-induced CSF leak complicating spinal surgery.
abstract: A 72-year-old woman was admitted for elective L4/L5 laminectomy. The operative procedure was extradural, and a Jackson-Pratt (JP) drain was placed in the tissue bed and set to wall suction during skin closure. During closure, the patient developed a 15 s period of asystole. The patient was haemodynamically stable, but was comatose for 3 days postoperatively. Cardiac enzymes and EEG were unrevealing. Head CT showed traces of subarachnoid haemorrhage and signs suggestive of cerebral anoxia. JP drain at the incision produced 170-210 mL/day of fluid, positive for β-2 transferrin, indicating cerebrospinal fluid (CSF). The patient fully returned to baseline on hospital day 10. MRI on hospital day 8 normalised. The reversible coma and radiographic findings were most consistent with acute intracranial hypotension relating to acute loss of CSF. Because radiographic findings can mimic hypoxic-ischaemic injury, acute intracranial hypotension should be considered in the differential diagnosis of postoperative coma after cranial or spinal surgery.
authors.affiliation: Division of Neurocritical Care, Rhode Island Hospital/Brown University, Providence, Rhode Island, USA.
authors.forename: Corey R
authors.initials: CR
authors.lastname: Fehnel
authors.forename: Ali
authors.initials: A
authors.lastname: Razmara
authors.forename: Steven K
authors.initials: SK
authors.lastname: Feske
mesh_terms: D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003128:Coma / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D019585:Intracranial Hypotension / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D013396:Suction; D014057:Tomography, X-Ray Computed