Acute tonsillar cerebellar herniation in a patient with traumatic dural tear and VAC therapy after complex trauma.
BACKGROUND
Cases of cerebral hypotension and tonsillar herniation after accidental lumbar cerebrospinal fluid (CSF) drainage or chest tube drainage with intrathoracic CSF leaks have been reported. To the authors' knowledge, this case presents the first report of severe intracranial hypotension because of suction of CSF by a Vacuum-Assisted Closure (VAC) device.


OBJECTIVE
The purpose of this study was to report a life-threatening intracranial hypotension in a polytraumatized patient after VAC therapy.


METHODS
This study is a case report.


METHODS
A 23-year-old woman suffered of a Grade 3 open pelvic fracture after a motor vehicle accident. After a VAC therapy, the patient became nonresponsive. A cranial computer tomography (CCT) showed signs of intracranial hypotension with narrowing of the basal cisterns and sagging of the cerebellar tonsils. The VAC was removed. Further neuroradiological diagnostic showed a tear in the dural sac at the L5-S1 level. The patient consequently underwent neurosurgery. After a dural patch, she was oriented postoperatively and the CCT improved to a normal state.


RESULTS
Fifteen days after admission, the patient was discharged without neurologic sequelae.


CONCLUSIONS
Severely injured patients undergoing VAC therapy with secondary neurologic deterioration not because of head injury should be appropriately diagnosed to rule out dural laceration and cranial hypotension.
Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany. Electronic address: peter.sporns@ukmuenster.de.
Peter Bernhard
PB
Sporns
Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Sebastian
S
Zimmer
Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Uta
U
Hanning
Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Tarek
T
Zoubi
Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Johannes
J
Wölfer
Department of Trauma Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Mirco
M
Herbort
Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Wolfram
W
Schwindt
Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Thomas
T
Niederstadt
D000063:Accidents, Traffic; D065634:Cerebrospinal Fluid Leak / Q000209:etiology* / Q000601:surgery; D004677:Encephalocele / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology* / Q000601:surgery; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D055815:Young Adult
Cerebrospinal fluid; Dural tear; Intracranial hypotension; Tonsillar herniation; Trauma; VAC