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Intracranial hypotension producing reversible coma: a systematic review, including three new cases
Joshua J Loya1, Stefan A Mindea, Hong Yu
1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305-5487, USA.
Journal of Neurosurgery
|June 26, 2012
Summary
Intracranial hypotension from spinal cerebrospinal fluid (CSF) leakage can cause coma, often misdiagnosed. Prompt diagnosis and epidural blood patches offer a high recovery rate for this serious condition.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Intracranial hypotension, characterized by cerebrospinal fluid (CSF) hypovolemia due to spinal CSF leakage, can rarely lead to coma.
- Positional headaches are a common initial symptom, but misdiagnosis is frequent, delaying appropriate treatment.
Observation:
- A review of 29 cases (including 3 new ones) of intracranial hypotension-associated coma revealed that most patients initially presented with headache.
- Subdural collections were found in 86% of patients, but intracranial hypotension was often overlooked as the cause.
- Procedures to evacuate subdural collections provided only transient improvement, with some patients deteriorating further.
Findings:
- Diagnosis of intracranial hypotension was typically made via MRI, often after failed treatments for presumed subdural hematoma (SDH).
- Epidural blood patches proved curative in 85% of patients once intracranial hypotension was correctly diagnosed.
- 93% of patients experienced favorable outcomes after diagnosis and treatment, with a mortality rate of 3.4%.
Implications:
- The study proposes diagnostic criteria for intracranial hypotension in comatose patients and a management algorithm to improve recognition and treatment.
- Early identification and treatment of intracranial hypotension are crucial to prevent severe neurological deficits and mortality.
- Recognizing the link between spinal procedures, SDH, and intracranial hypotension is vital for patient outcomes.
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