Brain stem and cerebellar dysfunction after lumbar spinal fluid drainage: case report

Details

Serval ID
serval:BIB_85967C2B1C38
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Brain stem and cerebellar dysfunction after lumbar spinal fluid drainage: case report
Journal
Journal of Neurology Neurosurgery and Psychiatry
Author(s)
Bloch  J., Regli  L.
ISSN
0022-3050
Publication state
Published
Issued date
07/2003
Peer-reviewed
Oui
Volume
74
Number
7
Pages
992-4
Notes
Case Reports
Journal Article --- Old month value: Jul
Abstract
Lumbar spinal fluid drainage is a common procedure to reduce the risks of cerebrospinal fluid (CSF) fistula after skull base fractures or various transdural neurosurgical procedures. Nevertheless, this simple and effective technique can lead to overdrainage and CSF hypovolaemia. This report describes the case of a young patient who had a lumbar drain inserted, to avoid CSF fistula after a pterional craniotomy with opening of the frontal sinus for the clipping of a ruptured aneurysm. The drain was removed after 48 hours because of underdrainage (<1 ml/h). Three days after drain removal, she developed rapid deterioration of her level of consciousness and signs of cranial nerves involvement, brain stem and cerebellar dysfunction. Intracranial pressure was low (<5 cm H(2)O) and MRI showed brain sagging and cerebellar foramen magnum herniation. The patient was successfully treated with epidural blood patch, ventricular drainage, and Trendelenburg position. The authors report this case because CSF hypovolaemia attributable to lumbar overdrainage is an insidious and threatening condition not easy to diagnose in the absence of detectable CSF leak. MRI and intracranial pressure monitoring confirm the diagnosis and permit better understanding of the physiopathology of brain sagging.
Keywords
Adult Aneurysm, Dissecting/complications Aneurysm, Ruptured/*surgery Brain Stem/*pathology Carotid Artery Diseases/complications Cerebellar Diseases/*etiology *Cerebrospinal Fluid Cerebrospinal Fluid Pressure Craniotomy/*adverse effects Drainage/adverse effects Female Fistula/etiology/prevention & control Humans Lumbar Vertebrae Magnetic Resonance Imaging Postoperative Complications/*prevention & control Subarachnoid Hemorrhage/etiology/*surgery
Pubmed
Web of science
Open Access
Yes
Create date
06/02/2008 10:03
Last modification date
20/08/2019 14:44
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