Abstract
We report the use of an emergent, targeted fibrin spinal epidural blood patch with subarachnoid saline infusion to rapidly reverse "in-extremis" clinical and imaging signs of posterior-fossa coning brought about by acute-on-chronic intracranial hypotension, itself consequent to a cervicothoracic CSF leak. Treatment resulted in a dramatic recovery and eventual discharge with return to normal lifestyle and occupation. The clinical and imaging danger signs are reviewed; fibrin patch technique and potential pitfalls in postprocedure management are analyzed.
MeSH terms
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Blood Patch, Epidural*
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Cervical Vertebrae / pathology
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Cervical Vertebrae / surgery
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Craniotomy
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Diagnosis, Differential
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Emergencies*
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Encephalocele / diagnosis
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Encephalocele / surgery
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Hematoma, Subdural / diagnosis
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Hematoma, Subdural / surgery
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Humans
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Image Enhancement
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Intracranial Hypotension / diagnosis
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Intracranial Hypotension / surgery*
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Magnetic Resonance Imaging
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Male
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Middle Aged
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Myelography
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Neurologic Examination
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Neuronavigation*
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Recurrence
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Reoperation
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Subdural Effusion / diagnosis
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Subdural Effusion / surgery*
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Thoracic Vertebrae / pathology
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Thoracic Vertebrae / surgery
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Tomography, X-Ray Computed