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Reversible Coma: A Rare Presentation of Spontaneous Intracranial Hypotension

Published online by Cambridge University Press:  02 December 2014

Jodi L. Kashmere ,
Michael J. Jacka ,
Derek Emery  and
Donald W. Gross
Jodi L. Kashmere
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Michael J. Jacka
Affiliation:
Department of Anesthesiology, Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada
Derek Emery
Affiliation:
Department of Radiology and Diagnostic Imaging, Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
Donald W. Gross
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract

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Background:

Spontaneous intracranial hypotension (SIH) is a well-recognized neurologic disorder that typically presents with orthostatic headaches, low cerebral spinal fluid pressures and distinct abnormalities on magnetic resonance imaging.

Methods:

We present a case of a rare presentation of SIH.

Results:

A 49-year-old man presented with a two week history of orthostatic headaches that rapidly progressed to encephalopathy and coma, requiring intubation. Neuroimaging revealed abnormalities typical of SIH; diffusely enhancing pachymeninges, subdural fluid collections, and descent of the brain. Treatment with an epidural blood patch reversed his coma within minutes. Following a second blood patch, the patient became asymptomatic. No cerebral spinal leak could be identified on magnetic resonance imaging or on a nuclear medicine technetium cerebral spinal fluid flow study. At six month follow-up, he remained symptom free.

Conclusion:

The mechanism of coma in SIH is presumed to be compression of the diencephalon from downward displacement of the brain. Although it is very unusual for patients with SIH to present with coma, it is important to recognize since the coma may be reversible with epidural blood patches.

Type
Other
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 4 , November 2004 , pp. 565 - 568
Copyright
Copyright © The Canadian Journal of Neurological 2004

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