Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons
Spontaneous intracranial hypotension (SIH) is rare. It presents as intractable posture headache and is identified by radiological findings. It is confirmed by cerebrospinal fluid (CSF) manometry and myelography, and treatment is carried out with the help of epidural blood patch (EBP) therapy. SIH pr...
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| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2021-01-01
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| Series: | Indian Journal of Neurosurgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1721203 |
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| author | Venugopal Subramaniam Sibhi Ganapathy S. Shivananda K. N. Nagabhushan Raghu Murthy |
| author_facet | Venugopal Subramaniam Sibhi Ganapathy S. Shivananda K. N. Nagabhushan Raghu Murthy |
| author_sort | Venugopal Subramaniam |
| collection | DOAJ |
| description | Spontaneous intracranial hypotension (SIH) is rare. It presents as intractable posture headache and is identified by radiological findings. It is confirmed by cerebrospinal fluid (CSF) manometry and myelography, and treatment is carried out with the help of epidural blood patch (EBP) therapy. SIH presenting with spontaneous bilateral recurrent subdural bleeds is uncommon. The cause being a high-spinal CSF leak is even more uncommon! Our patient had recurrent bilateral spontaneous chronic subdural hematomas. Myelographic examination of the spine showed a C1–C2 level leak of CSF. He was taken up for open microsurgery, and the leak was identified and closed with fibrin glue. The patient however deteriorated the next day. An EBP was applied in the lumbar region to cover the myelogram lumbar puncture site. We present a review of literature and an algorithm to detect the elusive CSF leak and effect definitive treatment, either open or EBP, to treat the source of the problem. |
| format | Article |
| id | doaj-art-3bb0e5a95f144b4d9ed5b3289d0e15a0 |
| institution | OA Journals |
| issn | 2277-954X 2277-9167 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Neurosurgery |
| spelling | doaj-art-3bb0e5a95f144b4d9ed5b3289d0e15a02025-08-20T02:08:00ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Neurosurgery2277-954X2277-91672021-01-01100100601210.1055/s-0040-1721203Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for NeurosurgeonsVenugopal Subramaniam0Sibhi Ganapathy1S. Shivananda2K. N. Nagabhushan3Raghu Murthy4Department of Neurosurgery, Manipal Hospital Whitefield, Bangalore, Karnataka, IndiaDepartment of Neurosurgery, Manipal Hospital Whitefield, Bangalore, Karnataka, IndiaDepartment of Anesthesiology, Manipal Hospital Whitefield, Bangalore, Karnataka, IndiaDepartment of Radiodiagnostics, Manipal Hospital Whitefield, Bangalore, Karnataka, IndiaDepartment of Radiodiagnostics, Manipal Hospital Whitefield, Bangalore, Karnataka, IndiaSpontaneous intracranial hypotension (SIH) is rare. It presents as intractable posture headache and is identified by radiological findings. It is confirmed by cerebrospinal fluid (CSF) manometry and myelography, and treatment is carried out with the help of epidural blood patch (EBP) therapy. SIH presenting with spontaneous bilateral recurrent subdural bleeds is uncommon. The cause being a high-spinal CSF leak is even more uncommon! Our patient had recurrent bilateral spontaneous chronic subdural hematomas. Myelographic examination of the spine showed a C1–C2 level leak of CSF. He was taken up for open microsurgery, and the leak was identified and closed with fibrin glue. The patient however deteriorated the next day. An EBP was applied in the lumbar region to cover the myelogram lumbar puncture site. We present a review of literature and an algorithm to detect the elusive CSF leak and effect definitive treatment, either open or EBP, to treat the source of the problem.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1721203spontaneous intracranial hypotensionrecurrent subdural hematomasbilateral subdural hematomasspontaneous spinal dural leaks |
| spellingShingle | Venugopal Subramaniam Sibhi Ganapathy S. Shivananda K. N. Nagabhushan Raghu Murthy Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons Indian Journal of Neurosurgery spontaneous intracranial hypotension recurrent subdural hematomas bilateral subdural hematomas spontaneous spinal dural leaks |
| title | Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons |
| title_full | Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons |
| title_fullStr | Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons |
| title_full_unstemmed | Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons |
| title_short | Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons |
| title_sort | recurrent spontaneous bilateral subdural hemorrhage as a consequence of high cervical spontaneous csf leak lessons for neurosurgeons |
| topic | spontaneous intracranial hypotension recurrent subdural hematomas bilateral subdural hematomas spontaneous spinal dural leaks |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1721203 |
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