Coma

Schievink, Wouter I.; Maya, M. Marcel; Moser, Franklin G.; Jean-Pierre, Stacey; Nuño, Miriam A

doi:10.1212/wnl.0000000000005477

Cited by 54 publications

(6 citation statements)

References 39 publications

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“…1 In severe cases, the disease can progress to cranial nerve palsies and even coma. [2][3][4] The nonspecific nature of the clinical presentation can result in considerable delays in workup, mimicking entities with drastically different treatments such as migraine, meningitis, or psychogenic disorders. 5 The diagnosis is made clinically, based on the International Classification of Headache Disorders, 3rd edition, which requires a headache that develops in temporal relation with one of either low CSF pressure (Ͻ 60 mm of CSF) or imaging features demonstrating or suggestive of CSF leak.…”

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confidence: 99%

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

Wang

Pandey

Lee

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Classic findings of intracranial hypotension on MR imaging, such as brain stem slumping, can be variably present and, at times, subjective, potentially making the diagnosis difficult. We hypothesize that the angle between the cerebral peduncles correlates with the volume of interpeduncular cistern fluid and is decreased in cases of intracranial hypotension. We aimed to investigate its use as an objective assessment for intracranial hypotension. MATERIALS AND METHODS: Brain MRIs of 30 patients with intracranial hypotension and 30 age-matched controls were evaluated by 2 fellowship-trained neuroradiologists for classic findings of intracranial hypotension and the interpeduncular angle. Group analysis was performed with a Student t test, and receiver operating characteristic analysis was used to identify an ideal angle threshold to maximize sensitivity and specificity. Interobserver reliability was assessed for classic findings of intracranial hypotension using the Cohen value, and the interpeduncular angle, using the intraclass correlation. RESULTS: The interpeduncular angle had excellent interobserver reliability (intraclass correlation coefficient value ϭ 0.833) and was significantly lower in the intracranial hypotension group compared with the control group (25.3°versus 56.3°; P Ͻ .001). There was significant correlation between the interpeduncular angle and the presence of brain stem slumping (P Ͻ .001) and in cases with Ն3 classic features of intracranial hypotension (P ϭ .01). With a threshold of 40.5°, sensitivity and specificity were 80% and 96.7%, respectively. CONCLUSIONS: The interpeduncular angle is a sensitive and specific measure of intracranial hypotension and is a reliably reproducible parameter on routine clinical MR imaging.

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confidence: 99%

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

Wang

Pandey

Lee

et al. 2019

AJNR Am J Neuroradiol

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“…[ 7 , 15 ] The main clinical sign of these patients is an impaired level of consciousness that spans from somnolence to coma; it can be attributed to either intracranial hypotension (brain sagging) or the compressive effect of the hematoma. [ 3 , 11 ] It is important to differentiate patients with “primary” SDH and SDHs due to SIH. Patients with SIH will most likely be younger (median age of 40) and have additional findings on CT scans such as brain sagging and pseudo-subarachnoid hemorrhage features.…”

Section: Discussionmentioning

confidence: 99%

Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension – A non-reported complication

Perez‐Vega

Robles-Lomelín

Robles-Lomelin

et al. 2020

Surgical Neurology International

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Background: Spontaneous intracranial hypotension (SIH) is an uncommon, benign, and generally self-limiting condition caused by low cerebrospinal fluid (CSF) volume and pressure usually caused by a CSF leak. Patients with SIH have an increased incidence of subdural hematomas (SDH), which may be bilateral and recurrent. Case Description: We report a unique case of a man presenting with SIH and bilateral SDH that were drained with bilateral craniotomies. During drain removal, the patient had an acute neurological deterioration and a CT scan showed SDH recurrence. The patient had two new recurrent SDH afterwards. After the third surgical intervention, the drain was removed in the OR with concomitant subdural saline infusion, there was no recurrence of SDH after that and the patient has had no further complications after a 2-year follow-up. Conclusion: Patients with intracranial hypotension are predisposed to form SDH. In this case, drain removal caused further decrease in intracranial pressure and triggered a new SDH formation, subdural saline irrigation masked atmospheric pressure and prevented this complication from happening again.

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“…Считается, что одним из основных патогномоничных симптомов при вышеупомянутой патологии является ортостатическая головная боль. Однако вследствие мозгового провисания, неизменно присутствующего и ведущего к дисфункции ствола мозга и ретикулярной формации, может развиться коматозное состояние [26,[35][36][37].…”

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“…Rossiiskaya otorinolaringologiya очередь, на типичных для СВГ результатах МРТисследования головного мозга, часто не учитывая, что определенное количество пациентов может не иметь типичной позиционной цефалгии или может присутствовать парадоксальная головная боль, которая уменьшается в вертикальном положении и усиливается в горизонтальном [37,41,42].…”

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“…При устранении признаков сердечно-сосудистой недостаточности может потребоваться даже интубация трахеи с проведением ИВЛ [34,37,43,44]. При крайне негативном развитии СВГ известны преценденты с летальным исходом [45][46][47].…”

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A look at the medical history of Prosper Meniere’s patient from modern perspectives

Egorov¹,

Sambulov²,

Kozarenko³

et al. 2020

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The review summarizes information on the stages of independent assessments of the cause of patient death, presented in 1861 by Prosper Menier. The possibility of the presence of a symptom complex unknown to the author, characteristic of intracranial hypotension syndrome, is emphasized. Attention is drawn to the symptomatic similarity of neurological and common ENT diseases different in etiopathogenesis. The rarity of the onset of reduced intracranial pressure syndrome is questioned. Risk factors for intracranial hypotension syndrome are mentioned. A hypothetical justification of the cause of death in Prosper Menier is proposed.

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Coma

Abstract: Coma in SIH is rare, reversible, and invariably associated with brain sagging. Coma due to SIH may be refractory to the usual percutaneous procedures, and surgical closure of the CSF leak may be required to regain consciousness.

Cited by 54 publications

References 39 publications

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI

Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension – A non-reported complication

A look at the medical history of Prosper Meniere’s patient from modern perspectives

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