Intrathecal saline infusion as an effective temporizing measure in the management of spontaneous intracranial hypotension.

Intrathecal saline infusion as an effective temporizing measure in the management of spontaneous intracranial hypotension.

World Neurosurg. 2019 Feb 01;:

Authors: Muram S, Yavin D, DuPlessis S

Abstract
BACKGROUND: Spontaneous intracranial hypotension is a rare condition for which no optimal treatment guidelines have been determined. The most common presentation is orthostatic headaches, but patients can present with a variety of symptoms.
CASE DESCRIPTION: We present a case of a 34 year old male who developed progressive orthostatic headaches and bilateral subdural collections. His symptoms along with imaging of his brain and spine were consistent with SIH. Unfortunately, his symptoms continued to progress, and his level of consciousness became affected. The patient failed both conservative management and epidural blood patching. Due to his worsening condition, a lumbar drain was inserted for the intrathecal infusion of normal saline to prevent tonsillar herniation. Once the infusion was started his level of consciousness improved. It was discovered that his CSF leak was due to an osteophyte within his thoracic spine, which was eroding the dura. He underwent a costo-transversectomy with the removal of the osteophyte and repair of the dural defect. The patient had some improvement after this procedure, but he remained more somnolent then expected. On subsequent imaging, it was found that his subdural collections had increased slightly in size and it was decided to drain them. Both collections were released under high pressure, and he went on to make an excellent recovery.
CONCLUSION: This case demonstrates that an intrathecal saline infusion can be used as an effective temporizing measure in patient's with critical symptoms of SIH and it also alerts clinicians that low pressure subdural collections can progress to subdural collections under high pressure.

PMID: 30716492 [PubMed - as supplied by publisher]

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