The Experts below are selected from a list of 927 Experts worldwide ranked by ideXlab platform
Robert A Fishman - One of the best experts on this subject based on the ideXlab platform.
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intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension technical case report
Neurosurgery, 2002Co-Authors: Devin K Binder, William P. Dillon, Robert A Fishman, Meic H SchmidtAbstract:OBJECTIVE AND IMPORTANCE Spontaneous intracranial hypotension is an increasingly recognized cause of Postural Headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined.CLINICAL PRESENTATION A 43-year-old man presented with Postural Headache follo
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intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension technical case report
Neurosurgery, 2002Co-Authors: Devin K Binder, William P. Dillon, Robert A Fishman, Meic H SchmidtAbstract:OBJECTIVE AND IMPORTANCE: Spontaneous intracranial hypotension is an increasingly recognized cause of Postural Headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined. CLINICAL PRESENTATION: A 43-year-old man presented with Postural Headache followed by rapid decline in mental status. Imaging findings were consistent with the diagnosis of spontaneous intracranial hypotension, with bilateral subdural hematomas, pachymeningeal enhancement, and caudal displacement of posterior fossa structures and optic chiasm. INTERVENTION: Despite treatment with lumbar epidural blood patch, worsening stupor necessitated intubation and mechanical ventilation. Contrast-enhanced magnetic resonance imaging and computed tomographic myelography of the spine failed to demonstrate the site of cerebrospinal fluid fistula. The enlarging subdural fluid collections were drained, and a ventriculostomy was performed. Postoperatively, the patient remained semicomatose. To restore intraspinal and intracranial pressures, intrathecal infusion of saline was initiated. After several hours of lumbar saline infusion, lumbar and intracranial pressures normalized, and the patient's stupor resolved rapidly. Repeat computed tomographic myelography accomplished via C1-C2 puncture demonstrated a large ventrolateral T1-T3 leak, which was treated successfully with a thoracic epidural blood patch. Follow-up magnetic resonance imaging demonstrated resolution of intracranial hypotension, and the patient was discharged in excellent condition. CONCLUSION: Spontaneous intracranial hypotension may cause a decline of mental status and require lumbar intrathecal saline infusion to arrest or reverse impending central (transtentorial) herniation. This case demonstrates the use of simultaneous monitoring of lumbar and intracranial pressures to appropriately titrate the infusion and document resolution of intracranial hypotension. Maneuvers aimed at sealing the cerebrospinal fluid fistula then can be performed in a less emergent fashion after the patient's mental status has stabilized.
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spontaneous intracranial hypotension report of two cases and review of the literature
Neurology, 1992Co-Authors: Thomas A Rando, Robert A FishmanAbstract:We report two patients with spontaneous intracranial hypotension. In addition to the cardinal features of a Postural Headache and a low CSF pressure, the patients also had subdural fluid collections demonstrated by head MRI. In both patients, radionuclide cisternography revealed a CSF leak along the spinal axis and rapid accumulation of radioisotope in the bladder. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The Headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Associated symptoms, including tinnitus and vertigo, and subdural fluid collections are presumably from hydrostatic changes among intracranial fluid compartments that occur at low CSF pressures. Methods of treatment are identical to those for post-dural puncture Headaches. Epidural blood patches and epidural saline infusions have rapidly ameliorated the symptoms of spontaneous intracranial hypotension.
Meic H Schmidt - One of the best experts on this subject based on the ideXlab platform.
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intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension technical case report
Neurosurgery, 2002Co-Authors: Devin K Binder, William P. Dillon, Robert A Fishman, Meic H SchmidtAbstract:OBJECTIVE AND IMPORTANCE Spontaneous intracranial hypotension is an increasingly recognized cause of Postural Headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined.CLINICAL PRESENTATION A 43-year-old man presented with Postural Headache follo
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intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension technical case report
Neurosurgery, 2002Co-Authors: Devin K Binder, William P. Dillon, Robert A Fishman, Meic H SchmidtAbstract:OBJECTIVE AND IMPORTANCE: Spontaneous intracranial hypotension is an increasingly recognized cause of Postural Headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined. CLINICAL PRESENTATION: A 43-year-old man presented with Postural Headache followed by rapid decline in mental status. Imaging findings were consistent with the diagnosis of spontaneous intracranial hypotension, with bilateral subdural hematomas, pachymeningeal enhancement, and caudal displacement of posterior fossa structures and optic chiasm. INTERVENTION: Despite treatment with lumbar epidural blood patch, worsening stupor necessitated intubation and mechanical ventilation. Contrast-enhanced magnetic resonance imaging and computed tomographic myelography of the spine failed to demonstrate the site of cerebrospinal fluid fistula. The enlarging subdural fluid collections were drained, and a ventriculostomy was performed. Postoperatively, the patient remained semicomatose. To restore intraspinal and intracranial pressures, intrathecal infusion of saline was initiated. After several hours of lumbar saline infusion, lumbar and intracranial pressures normalized, and the patient's stupor resolved rapidly. Repeat computed tomographic myelography accomplished via C1-C2 puncture demonstrated a large ventrolateral T1-T3 leak, which was treated successfully with a thoracic epidural blood patch. Follow-up magnetic resonance imaging demonstrated resolution of intracranial hypotension, and the patient was discharged in excellent condition. CONCLUSION: Spontaneous intracranial hypotension may cause a decline of mental status and require lumbar intrathecal saline infusion to arrest or reverse impending central (transtentorial) herniation. This case demonstrates the use of simultaneous monitoring of lumbar and intracranial pressures to appropriately titrate the infusion and document resolution of intracranial hypotension. Maneuvers aimed at sealing the cerebrospinal fluid fistula then can be performed in a less emergent fashion after the patient's mental status has stabilized.
David Campbell - One of the best experts on this subject based on the ideXlab platform.
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postpartum Postural Headache due to superior sagittal sinus thrombosis mistaken for spontaneous intracranial hypotension
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2001Co-Authors: Mary E Chisholm, David CampbellAbstract:Purpose: To describe a case of superior sagittal sinus thrombosis in the puerperal period and the difficulties encountered in the diagnosis and management.
Eric J Russell - One of the best experts on this subject based on the ideXlab platform.
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superior sagittal sinus thrombosis in a patient with postdural puncture Headache
Regional Anesthesia and Pain Medicine, 2003Co-Authors: Honorio T Benzon, Muhammad S Iqbal, Martin S Tallman, Larry Boehlke, Eric J RussellAbstract:Background and Objective The occurrence of concomitant intracranial pathology in a patient with postdural puncture Headache (PDPH) is rare. We present a patient who had a superior sagittal sinus thrombosis in addition to his PDPH. The signs and symptoms of intracranial pathology in patients with dural puncture Headache, in addition to their Postural Headache, are discussed. Case Report A 32-year-old man with lymphoblastic lymphoma received treatment with daunorubicin, vincristine, and prednisone. He developed Postural Headache and severe nausea and vomiting after a diagnostic lumbar puncture. Magnetic resonance imaging (MRI) showed superior sagittal sinus (SSS) thrombosis and meningeal enhancement. An epidural blood patch was performed and enoxaparin was prescribed for 6 months. He has remained asymptomatic. Conclusions Patients with PDPH have classic Postural Headache. The occurrence of additional signs and symptoms should alert the clinician to the presence of intracranial pathology. Patients with lymphoblastic lymphoma who had treatment with L-asparaginase and steroid are predisposed to the development of cortical venous thrombosis and may have this syndrome in addition to a dural puncture Headache. Reg Anesth Pain Med 2003;28:64-67.
William P. Dillon - One of the best experts on this subject based on the ideXlab platform.
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idiopathic thoracic spinal cord herniation retrospective analysis supporting a mechanism of diskogenic dural injury and subsequent tamponade
American Journal of Neuroradiology, 2012Co-Authors: Marcel Brusramer, William P. DillonAbstract:BACKGROUND AND PURPOSE: tSCH in the absence of spinal trauma or surgery is a rare disorder for which numerous mechanisms have been proposed. Here, we have conducted an analysis of images in all published reports of idiopathic tSCH and identified evidence supporting a pathogenesis in which anterior dural erosion at thoracic levels generates a CSF leak that pushes adjacent spinal tissue to tamponade the dural defect, causing progressive myelopathy. Additionally, we describe a case of tSCH in which Postural Headache was a significant symptom before myelopathy. This finding suggests that tSCH pathogenesis may be related to spontaneous intracranial hypotension. MATERIALS AND METHODS: Published imaging from all available prior case reports in the scientific literature was reviewed to determine whether tSCH occurred at the disk or bone level. The presence of EDF, HNP, or an osteophyte in the spinal canal was determined from review of published images. Additionally, 3 previously unreported cases from the teaching files of our department were assessed by using these criteria. RESULTS: In greater than two-thirds (47 of 67) of identified cases with published images, tSCH occurred at a disk level. When assessment was possible, EDF, HNP, and osteophytes were present in 26.8%, 30.7%, and 26.2% of cases, respectively. Overall, 52.3% of cases with published images demonstrated evidence of these abnormalities. CONCLUSIONS: Our analysis of published imaging indicates that tSCH occurs preferentially at spinal levels and with imaging findings consistent with dural injury that support the proposed etiology of this disorder.
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intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension technical case report
Neurosurgery, 2002Co-Authors: Devin K Binder, William P. Dillon, Robert A Fishman, Meic H SchmidtAbstract:OBJECTIVE AND IMPORTANCE Spontaneous intracranial hypotension is an increasingly recognized cause of Postural Headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined.CLINICAL PRESENTATION A 43-year-old man presented with Postural Headache follo
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intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension technical case report
Neurosurgery, 2002Co-Authors: Devin K Binder, William P. Dillon, Robert A Fishman, Meic H SchmidtAbstract:OBJECTIVE AND IMPORTANCE: Spontaneous intracranial hypotension is an increasingly recognized cause of Postural Headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined. CLINICAL PRESENTATION: A 43-year-old man presented with Postural Headache followed by rapid decline in mental status. Imaging findings were consistent with the diagnosis of spontaneous intracranial hypotension, with bilateral subdural hematomas, pachymeningeal enhancement, and caudal displacement of posterior fossa structures and optic chiasm. INTERVENTION: Despite treatment with lumbar epidural blood patch, worsening stupor necessitated intubation and mechanical ventilation. Contrast-enhanced magnetic resonance imaging and computed tomographic myelography of the spine failed to demonstrate the site of cerebrospinal fluid fistula. The enlarging subdural fluid collections were drained, and a ventriculostomy was performed. Postoperatively, the patient remained semicomatose. To restore intraspinal and intracranial pressures, intrathecal infusion of saline was initiated. After several hours of lumbar saline infusion, lumbar and intracranial pressures normalized, and the patient's stupor resolved rapidly. Repeat computed tomographic myelography accomplished via C1-C2 puncture demonstrated a large ventrolateral T1-T3 leak, which was treated successfully with a thoracic epidural blood patch. Follow-up magnetic resonance imaging demonstrated resolution of intracranial hypotension, and the patient was discharged in excellent condition. CONCLUSION: Spontaneous intracranial hypotension may cause a decline of mental status and require lumbar intrathecal saline infusion to arrest or reverse impending central (transtentorial) herniation. This case demonstrates the use of simultaneous monitoring of lumbar and intracranial pressures to appropriately titrate the infusion and document resolution of intracranial hypotension. Maneuvers aimed at sealing the cerebrospinal fluid fistula then can be performed in a less emergent fashion after the patient's mental status has stabilized.