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Cervical bone spur presenting with spontaneous intracranial hypotension. Case report
A G Vishteh1, W I Schievink, J J Baskin
1Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, USA.
Journal of Neurosurgery
|September 2, 1998
Summary
A rare cause of spontaneous intracranial hypotension, a midline bone spur at C5-C6, was identified and surgically removed. This intervention resolved the patient's postural headaches and improved imaging findings.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Spontaneous intracranial hypotension (SIH) presents with postural headaches, often due to cerebrospinal fluid (CSF) leaks of unknown origin.
- Diagnosis involves imaging like MRI, showing characteristic findings such as pachymeningeal enhancement and hindbrain herniation.
Observation:
- A 32-year-old male presented with severe postural headaches, suggestive of SIH.
- Cerebral angiography was negative, but brain MRI revealed pachymeningeal enhancement and hindbrain herniation.
- Cervical myelography identified an unusual midline bone spur at C5-C6 with ventral extrathecal contrast material.
Findings:
- Surgical exploration revealed a bone spur piercing the thecal sac at C5-C6.
- Removal of the bone spur and closure of the dural rent led to symptom resolution.
- Post-operative MRI showed resolution of pachymeningeal enhancement and improvement in cerebellar herniation.
Implications:
- This case highlights a unique etiology for spontaneous intracranial hypotension.
- Surgical intervention for specific structural abnormalities can effectively treat SIH.
- Early diagnosis and targeted treatment are crucial for managing complex CSF leak cases.