Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report

Journal of Medical Case Reports

Seigo Matsuo¹  Atsushi Ishida¹ 

[1] Department of Neurosurgery, Moriyama Memorial Hospital, 7-12-7 Nishikasai, Edogawa-ku, Tokyo 134-8608, Japan

关键词: Brain sagging;    Cisternal irrigation;    Vasospasm;   

Others  :  1181044
DOI  :  10.1186/1752-1947-8-308

 received in 2014-04-04, accepted in 2014-07-21,  发布年份 2014

【 摘 要 】

Introduction

Vasospasm is the most common cause of complication after a subarachnoid hemorrhage and tremendous efforts have been made to prevent it. A subarachnoid clot is the cause of the vasospasm and dissolving and washing it out is considered to be the best practice. Cisternal irrigation with urokinase and ascorbic acid has been widely used due to its proven effect.

Case presentation

A 60-year-old Japanese male presented with a severe headache was diagnosed with a subarachnoid hemorrhage and an immediate surgical obliteration was successfully performed. After clipping the aneurysm, a cisternal drainage tube was placed in the chiasmatic cistern. In order to clear the thick subarachnoid hemorrhage, a cisternal irrigation was performed. However, his consciousness deteriorated and his left pupil became dilated on the next day. A T1 sagittal magnetic resonance imaging scan showed an evidence of marked brain sagging with mild tonsillar descent. We continued intensive hydration and head-down positioning and the brain sagging was shown to have improved in the follow-up magnetic resonance imaging scan.

Conclusions

We present a case in which our patient experienced brain sagging after a cisternal irrigation of a subarachnoid hemorrhage. A subdural hematoma and low intracranial pressure suggested intracranial hypotension. Sagittal magnetic resonance imaging images are useful to evaluate brain sagging and are shown sequentially here in our case report.

【 授权许可】

   
2014 Ishida and Matsuo; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Dorsch NW, King MT: A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage Part I: Incidence and effects. J Clin Neurosci 1994, 1:119-126.
• [2]Fisher CM, Kistler JR, Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980, 6:1-9.
• [3]Kodama N, Sasaki T, Kawakami M, Sato M, Asari J: Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients. Surg Neurol 2000, 53:110-117.
• [4]Rahman M, Bidari SS, Quisling RG, Friedman WA: Spontaneous intracranial hypotension: dilemmas in diagnosis. Neurosurgery 2011, 69:4-14.
• [5]Chung SJ, Kim JS, Lee MC: Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcome. Neurology 2000, 55:1321-1327.
• [6]Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B: Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurgery 1998, 88:237-242.
• [7]Hadizadeh DR, Kovacs A, Tschampa H: Postsurgical intracranial hypotension: diagnostic and prognostic imaging findings. AJNR American J Neuroradiology 2010, 31:100-105.
• [8]Mea E, Chiapparini L, Savoiardo M: Clinical features and outcomes in spontaneous intracranial hypotension: a survey of 90 consecutive patients. Neurol Sci 2009, 30:S11-S13.
• [9]Mokri B: Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache 2013, 53:1034-1053.