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Delayed Iatrogenic Intracranial Hypotension After Thoracotomy
Christine K Federspiel1, Jesper Kelsen2, Kåre Fugleholm3
1Department of Pulmonary and Infectious Medicine, Nordsjællands Hospital, Hillerød, Denmark.
The Annals of Thoracic Surgery
|January 7, 2020
Summary
Intracranial hypotension (IH) can occur after thoracotomy, presenting as severe headache or unconsciousness. Early detection of associated pneumocephalus and pneumorrhachis may indicate a fistula, preventing serious complications.
Area of Science:
- Neurosurgery
- Thoracic Surgery
- Radiology
Background:
- Intracranial hypotension (IH) is a condition characterized by low cerebrospinal fluid pressure.
- Thoracotomy, a surgical procedure, can sometimes lead to complications affecting intracranial pressure.
- Pneumocephalus and pneumorrhachis are air collections within the skull and spinal canal, respectively.
Observation:
- A 56-year-old woman developed severe headache due to pneumocephalus and pneumorrhachis 10 days post-left upper lobectomy.
- The patient later presented with unconsciousness and signs of IH and "sagging brain."
- Magnetic resonance imaging identified a fistula at the left Th5 pedicle.
Findings:
- The initial symptoms of pneumocephalus and pneumorrhachis resolved with conservative management.
- A persistent subarachnoid-pleural fistula was diagnosed as the cause of recurrent IH.
- Surgical closure of the fistula led to complete patient recovery.
Implications:
- Pneumocephalus and pneumorrhachis following thoracotomy warrant suspicion for a persistent subarachnoid-pleural fistula.
- Timely diagnosis and surgical intervention can prevent severe neurological deficits associated with IH.
- This case highlights the importance of recognizing rare complications after thoracic surgery.
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