Coma from wall suction-induced CSF leak complicating spinal surgery.
Corey R Fehnel1, Ali Razmara, Steven K Feske
1Division of Neurocritical Care, Rhode Island Hospital/Brown University, Providence, Rhode Island, USA.
BMJ Case Reports
|March 14, 2014
Summary
A patient developed reversible coma after spinal surgery due to cerebrospinal fluid (CSF) loss, leading to intracranial hypotension. This condition can mimic hypoxic-ischaemic injury in postoperative patients.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Spinal laminectomy carries risks, including potential complications affecting neurological function.
- Postoperative monitoring is crucial for identifying and managing emergent conditions.
- Cerebrospinal fluid (CSF) leaks can lead to significant intracranial pressure changes.
Observation:
- A 72-year-old female patient undergoing L4/L5 laminectomy experienced intraoperative asystole and 3-day postoperative coma.
- Diagnostic workup revealed subarachnoid hemorrhage and signs of cerebral anoxia on CT scan.
- The Jackson-Pratt drain produced significant fluid testing positive for beta-2 transferrin, indicative of CSF.
Findings:
- The patient's symptoms and imaging findings were consistent with acute intracranial hypotension.
- The condition was directly linked to substantial acute loss of cerebrospinal fluid (CSF).
- Neurological and radiographic abnormalities resolved completely with supportive care.
Implications:
- Acute intracranial hypotension due to CSF loss is a critical differential diagnosis for postoperative coma.
- Radiographic findings of intracranial hypotension can be misdiagnosed as hypoxic-ischaemic injury.
- Early recognition and management of CSF leaks are vital to prevent severe neurological sequelae.
More Related Videos
06:59Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
Published on: February 29, 2020
7.5K
14:59Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
12.3K
Related Concept Videos
01:14Increased Intracranial Pressure l: Introduction
27
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component...
27
01:22Aneurysm IV: Nursing Management
621
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
621
01:22Cerebral Edema ll: Pathophysiology
19
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
19
01:26Brain Abscess l: Introduction
21
A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial...
21
01:29Suctioning the Nasopharyngeal Airway
6.5K
Nasopharyngeal suctioning is a procedure to remove secretions from the upper part of the respiratory tract that the patient cannot clear independently. It helps maintain airway patency and prevents complications such as aspiration pneumonia.
Equipment Required
Equipment Required
6.5K
01:29Increased Intracranial Pressure ll: Pathophysiology
20
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins...
20