+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Intracranial hypotension as a complication of lumbar puncture prior to elective aneurysm clipping

Intracranial hypotension as a complication of lumbar puncture prior to elective aneurysm clipping

Surgical Neurology International 5(Suppl 9): S427-S429

Lumbar dural defects are an uncommon but important cause of persistent intracranial hypotension in the neurosurgical population. We present a case of intracranial hypotension after elective craniotomy due to a lumbar puncture performed 3 weeks earlier. A 55-year-old female underwent uneventful craniotomy for clipping of an unruptured left middle cerebral artery bifurcation aneurysm. Postoperatively, the patient showed a gaze deviation and failed to wake up. Computed tomography demonstrated significant postoperative pneumocephalus. Family members indicated that the patient underwent a lumbar puncture 3 weeks prior to surgery to rule out a subarachnoid hemorrhage. The excessive pneumocephalus was initially interpreted as a result of spinal cerebrospinal fluid leak, and the patient was placed in the Trendelenburg position. This positioning resulted in some improvement in her mental status, although she was unable to tolerate any subsequent elevation in the head of her bed. Magnetic resonance imaging analysis of her spinal axis did not demonstrate any evidence of cerebrospinal fluid leak, but a subsequent lumbar blood patch resulted in rapid and dramatic improvement in the patient's status. She was subsequently discharged after an uneventful hospital stay. Although uncommon, persistent intracranial hypotension caused by lumbar dural defects must be considered in patients who have recently undergone procedures that compromise the lumbar dura because prompt intervention can significantly improve the patient's condition.

(PDF emailed within 0-6 h: $19.90)

Accession: 053939846

Download citation: RISBibTeXText

PMID: 25324976

DOI: 10.4103/2152-7806.141751

Related references

Secondary pneumocephalus after lumbar puncture: an unusual complication of spontaneous intracranial hypotension?. Clinical Neurology and Neurosurgery 115(10): 2204-2206, 2014

Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping. Case report. Journal of Neurosurgery 73(6): 962-964, 1990

Severe hypotension with intracisternal application of papaverine after clipping of an intracranial aneurysm. Surgical Neurology 72(6): 770-771, 2010

Symptomatic epidural cerebrospinal fluid collection following lumbar puncture and aneurysm clipping. Clinical Neurology and Neurosurgery 115(6): 778-780, 2014

Post-lumbar puncture intracranial hypotension. Neurological Sciences 22(5): 411-2;discussion 412., 2002

MRI meningeal enhancement with intracranial hypotension caused by lumbar puncture. Pediatric Neurology 16(2): 163-165, 1997

Life-threatening intracranial hypotension after diagnostic lumbar puncture. Neurological Sciences 22(5): 385-389, 2002

Prophylaxis of intracranial hypotension syndrome and headache following lumbar puncture. Neurologia 17(6): 346-7; Author Reply 347-9, 2002

Can physicians prevent post-lumbar puncture headache or intracranial hypotension?. Journal of Neurosciences in Rural Practice 6(2): 131-132, 2015

Intracranial hypotension with subdural hematoma following lumbar puncture: case report. Neuro-Chirurgie 54(2): 85-88, 2008

Postcontrast meningeal MR enhancement secondary to intracranial hypotension caused by lumbar puncture. Journal of Computer Assisted Tomography 19(2): 299-301, 1995

Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture. International Journal of General Medicine 7(): 71-73, 2014

Giant cervical epidural veins after lumbar puncture in a case of intracranial hypotension. Ajnr. American Journal of Neuroradiology 21(4): 787-789, 2000

Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review. Journal of Cerebrovascular and Endovascular Neurosurgery 17(4): 318-323, 2016

Local cortical blood flow and oxygen consumption during isoflurane-induced hypotension. Results in patients undergoing intracranial aneurysm clipping. Cleveland Clinic Journal of Medicine 56(8): 766-770, 1989