Spontaneous intracranial hypotension: trendelenberg just may be the answer.
Spontaneous intracranial hypotension may share some characteristics with the more common causes of headaches such as migraines or tension headaches, but its diagnosis and treatment is much more laborious and invasive. Here, the case of a 31-year-old man with multiple weeks of positional headaches is described. This symptom persisted following multiple blood patches, and progressed to worsening mental status, encephalopathy, and eventually obtundation with Glascow Coma Score less than 8. Surgery was required; however, small improvement was seen on imaging or in the patient's status. When the patient's position was changed to 20 degrees of Trendelenberg, immediate improvement was seen, leading to a full recovery. Although epidural blood patch is considered the treatment mainstay for spontaneous intracranial hypotension, this case shows another factor to consider in the treatment of this difficult condition.
Naval Aerospace Medicine Institute, 340 Hulse Road, Pensacola, FL 32508.
Krista K
KK
Koch
Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, 720 John Paul Jones Circle, Portsmouth, VA 23708.
Thomas J
TJ
Moran
D000328:Adult; D017217:Blood Patch, Epidural; D003128:Coma / Q000209:etiology; D018475:Head-Down Tilt; D006261:Headache / Q000209:etiology; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000628:therapy*; D008297:Male; D008889:Military Personnel; D014481:United States