Angiographic features of "brain sag"

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Cerebrospinal fluid hypotension, or "brain sag," is a post-craniotomy complication.
• It is often mistaken for cerebral vasospasm, leading to diagnostic challenges.

Purpose of the Study:

• To describe the angiographic findings in patients experiencing "brain sag."
• To identify characteristic imaging signs of brain sag.

Main Methods:

• Retrospective review of 5 patients diagnosed with brain sag after ruptured aneurysm surgery.
• Analysis of cerebral angiograms obtained during symptomatic brain sag and, in some cases, after resolution.

Main Results:

• Inferior displacement and kinking of the basilar artery (cobra sign) were observed in all patients.
• Foreshortening of vertebral arteries and medial/inferior displacement of posterior cerebral arteries were noted.
• Angiographic features reversed upon resolution of brain sag symptoms.

Conclusions:

• Brain sag is associated with distinct angiographic features.
• Identifying these characteristic angiographic signs can aid in diagnosing brain sag and guiding patient management.