University of Massachusetts Medical School Faculty Publications

UMMS Affiliation

Department of Neurology

Date

11-13-2013

Document Type

Article

Disciplines

Nervous System Diseases | Neurology

Abstract

Background. Undiagnosed intracranial hypotension can result in several complications including subdural hematoma (SDH), subarachnoid hemorrhage (SAH), dural venous sinuses thrombosis (CVT), cranial nerve palsies, and stupor resulting from sagging of the brain. It is rare to see all the complications in one patient. Furthermore, imaging of the brain vasculature may reveal incidental asymptomatic small aneurysms. Given the combination of these imaging findings and a severe headache, the patients are often confused to have a primary subarachnoid hemorrhage.

Case Report. We present a patient with spontaneous intracranial hypotension (SIH) who had an incidental ophthalmic artery aneurysm on MR imaging, and this presentation led to coiling of the aneurysm. The key aspect in the history "postural headaches" was missed, and this led to life threatening complications and unnecessary interventions. Revisiting the history and significant improvement in symptoms following an epidural blood patch resulted in the diagnosis of SIH.

Conclusion. We strongly emphasize that appropriate history taking is the key in the diagnosis of SIH and providing timely treatment with an epidural blood patch could prevent potentially life threatening complications.

Rights and Permissions

Citation: Case Rep Neurol Med. 2013;2013:913465. doi: 10.1155/2013/913465. Epub 2013 Nov 13. Link to article on publisher's site

Comments

Copyright © 2013 Swetha Ade and Majaz Moonis. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Related Resources

Link to Article in PubMed

PubMed ID

24324901

Creative Commons License

Creative Commons Attribution 3.0 License
This work is licensed under a Creative Commons Attribution 3.0 License.

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