好色先生

好色先生

Explore the latest content from across our publications
Join The AAN

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Iatrogenic Intracranial Hypotension with Pseudomeningocele, CSF Fistula and CSF Leak Following Dural Repair and Spinal Cord Stimulator Placement
Headache
P2 - Poster Session 2 (8:00 AM-9:00 AM)
12-005
We present a case of iatrogenic IH following traumatic dural injury due to SCS lead migration complicated by a large pseudomeningocele, CSF venous fistula (CVF), and CSF leaks.
Intracranial hypotension (IH) is a rare complication of cerebrospinal fluid (CSF) leakage. It can occur either spontaneously (primary) or because of trauma or medical intervention (secondary/iatrogenic). Iatrogenic IH can occur following procedures that involve dural injury, such as spinal surgery, spinal cord stimulator (SCS) lead migration, or lumbar puncture. Reduced CSF flow leads to a decrease in CSF volume and subsequent intracranial hypotension, manifesting as a postural headache.

A 47-year-old female presented with recurrent disabling postural headaches beginning in 2010 accompanied by tinnitus, a sensation of underwater hearing, autonomic dysfunction, confusion, and brain fog, raising concern for CSF leak. Surgical history included an L4-S1 posterior fusion and laminectomy complicated by durotomy and repair in 2003, followed by 2 epidural SCS placements and bilateral SI joint fusion. CT myelography revealed arachnoiditis and a large pseudomeningocele at L4-L5 without active CSF leak. She was treated empirically with an epidural blood patch, leading to cessation of her symptoms. Five months later after a fall, symptoms recurred. CT thoracic spine revealed migration of the lower SCS epidural lead into the thecal sac. Repeat CT myelogram showed multilevel CSF leaks. Dynamic CT myelogram raised suspicion for CVF versus systemic contrast absorption in the pseudomeningocele containing the CSF leak. She was treated with epidural fibrin glue blood patches, microsurgical repair of the pseudomeningocele with venous ligation, and a lumbar peritoneal shunt, resulting in significant improvement of her postural headache symptoms.
N/A
Iatrogenic IH can result from persistent, recurrent, or new CSF leaks even after dural repair. In those who develop new or ongoing postural headaches following treatment, re-evaluation of symptoms along with repeat CT myelography may be warranted.
Authors/Disclosures
Monika Mikolajczak, MD
PRESENTER 		Dr. Mikolajczak has nothing to disclose.
Melinda C. Arthur, DO (Western Neuro - Carondelet Medical) Dr. Arthur has nothing to disclose.
Rajesh Burela, DO Dr. Burela has nothing to disclose.
Samuel Lee, DO Dr. Lee has nothing to disclose.
Paul Wright, MD, FAAN (Amwright Consulting LLC) Dr. Wright has nothing to disclose.
Hida Nierenburg, MD (Nuvance Neurology) Dr. Nierenburg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer . Dr. Nierenburg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Nierenburg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Promius . Dr. Nierenburg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. Dr. Nierenburg has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. Nierenburg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer.