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March 18, 2014; 82 (11) Resident and Fellow Section

Teaching NeuroImages: A dangerous complication of spontaneous intracranial hypotension

Claudio Tana, Massimo Caulo, Emmanuele Tafuri, Angelo Di Vincenzo, Marco Tana, Maria Vittoria De Angelis, Andrea Mezzetti, Maria Adele Giamberardino
First published March 17, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000213
Claudio Tana
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Massimo Caulo
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Emmanuele Tafuri
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Angelo Di Vincenzo
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Marco Tana
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Maria Vittoria De Angelis
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Andrea Mezzetti
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Maria Adele Giamberardino
From the Center of Excellence on Headache (C.T., E.T., A.D.V., M.A.G.), Department of Medicine and Science of Aging (C.T., E.T., M.T., A.M., M.A.G.), and Institute for Advanced Biomedical Technologies (M.C.), “G. d'Annunzio” University, Chieti, Italy; and Neurology Ward (M.V.D.A.), S. S. Annunziata Hospital, Chieti, Italy.
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Citation
Teaching NeuroImages: A dangerous complication of spontaneous intracranial hypotension
Claudio Tana, Massimo Caulo, Emmanuele Tafuri, Angelo Di Vincenzo, Marco Tana, Maria Vittoria De Angelis, Andrea Mezzetti, Maria Adele Giamberardino
Neurology Mar 2014, 82 (11) e94-e95; DOI: 10.1212/WNL.0000000000000213

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A 43-year-old man presented with a nontraumatic orthostatic headache, spatial disorientation, and visual hallucinations (“colored flames”). General and neurologic examination were normal. Turbo spin echo T2-weighted MRI showed bilateral subdural fluid collection and venous sinus engorgement (figure, A), suggesting spontaneous intracranial hypotension (SIH). Two subdural hematomas were also found, the biggest (2.5 cm) with mass effect in the left hemisphere (figure, B). Spine MRI identified a small radicular cyst emerging from the left T1-T2 foramen as the putative cause of CSF leakage (figure, C and D). The patient underwent drainage of the largest hematoma with benefit. Though initially planned, epidural blood patch and surgical treatment of the radicular cyst were not performed because clinical and radiologic findings improved with hematoma drainage, bed rest, and hydration. At a 3-month follow-up, MRI documented complete resolution of the subdural collection and dimensional stability of the radicular cyst. SIH is often considered benign and treated conservatively,1but it can rarely manifest with serious complications requiring rapid surgical evaluation.2

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  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Download teaching slides: Neurology.org

  • © 2014 American Academy of Neurology
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