Low-Pressure Hydrocephalus and Shunt Malfunction Following a Lumbar Puncture in an Adult Reversed by an Epidural Blood Patch

Abstract

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Low-/Negative-Pressure Hydrocephalus: To Understand the Formation Mechanism from the Perspective of Clinicians

“…The authors believe that lumbar puncture decreases spinal SAS pressure, particularly when the patient is upright and CSF is continually sucked into the negative-pressure epidural space. 13 The spinal canal is a closed system, and decreased CSF pressure creates lower pressure in the spinal epidural venous system, enhancing the siphon effect and resulting in excessive cerebral venous blood outflow. 29 A drop in the periventricular deep venous pressure leads to an increase in the periventricular parenchymal pressure gradient and ventricular dilatation.…”

“…6 Wu et al classifies hydrocephalus according to ICP as follows: hypertensive hydrocephalus (ICP > 20 cm H 2 O), normal-pressure hydrocephalus (ICP between 7 and 20 cm H 2 O), low-pressure hydrocephalus (ICP between 0 and 7 cm H 2 O), and NePH (ICP 0 cm H 2 O). 7 Several researchers have proposed various theories on the pathophysiology of LPH/NePH and have gradually developed efficient therapeutic strategies based on case reports, for example, external ventricular drainage (EVD) with low or negative pressure, 5,7-10 endoscopic third ventriculostomy (ETV), 11 autologous blood patch, 12,13 neck or abdominal girth wearing, 7 rigid semi-decubitus position and manual pump compression, 6 . Maintaining a 10-to 15-degree head and foot high position, transfusion of 5% glucose, keeping mild hyponatremia [130-135 mmol/L], maintaining arterial carbon dioxide partial pressure >40 mm Hg, and using nimodipine and other vasodilators also had been proposed.…”