Spontaneous intracranial hypotension resulting in stupor caused by diencephalic compression

Abstract

A 51-year-old man had a 4-month history of progressive headache and gradual onset of somnolence. MRI suggested spontaneous intracranial hypotension (SIH) with diencephalic compression, but he did not improve after three epidural blood patches. He became alert following intrathecal saline infusion that normalized his CSF pressure. A CSF leak was noted on spinal MRI and confirmed with CT contrast myelography. Surgical ligation of a torn dural root sleeve isolating a ruptured Tarlov's cyst resulted in permanent cure.

Intracranial Hypotension Causing Reversible Frontotemporal Dementia and Coma

“…Over the next few days in hospital, his level of consciousness rapidly deteriorated, and he became comatose with no response to noxious or verbal stimuli. An intrathecal saline infusion (ITSI) was initiated via lumbar catheter and based on published reports 11 , although 25cc bolus and 10 cc/hr infusion rate was used. One hour after initiation of the infusion he became alert and responsive.…”

“…Previously unrevealing diagnostic investigations were repeated with the ITSI running in an attempt to identify a CSF leak site 11,21 . Radionuclide cisternography demonstrated early tracer uptake in the kidneys and bladder, but failed to identify the leak location.…”

“…As such, alternative names of "CSF hypovolemia syndrome" and "spontaneous spinal CSF leak" have been proposed [4][5][6][7][8][9] . However, not all cases are "spontaneous", and underlying culprit lesions such as subarachnoid (Tarlov) cysts, other anatomical defects 3,5,[10][11][12][13] , or dural micro tears from minor trauma, neck manipulation and violent coughing 3,14,15 can lead to CSF leaks. Identifying the CSF leak site and interventional or surgical correction of the underlying defect is therefore necessary to permanently abate persisting symptoms.…”

“…Neurological manifestations include visual symptoms such as diplopia, visual blurring, field defects, or photophobia 16 , hearing abnormalities including tinnitus, distortions and sensory neural hearing loss 15,16 , various cranial nerve palsies, and even peripheral manifestations of interscapular pain or radicular symptoms 2,5,12,14 . Unusual clinical manifestations have been described in case reports and include parkinsonism, gait abnormalities, cerebellar ataxia 17 , bipolar disorder 18 , encephalopathy, cognitive changes (including one case of frontotemporal dementia [FTD]) 19 , obtundation and coma 11,[20][21][22][23] . Only one case of death related to SIH has been published to date 24 .…”

Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases

“…Spontaneous spinal CSF leaks occur less commonly and should be considered when an anatomical cause cannot be found. Causes of spinal CSF leakage include meningeal diverticules, nerve root sleeve tears, spinal osteophytes, spinal disc herniation, Tarlov cysts and iatrogenic dural tears [2,4,7,12].…”