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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2020; 81(04): e59-e65
DOI: 10.1055/s-0040-1722268
Case Report

Spontaneous Intracranial Hypotension Complicated by Subdural Effusions Treated by Surgical Relief of Cranial Venous Outflow Obstruction

J Nicholas Higgins
1   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Patrick R. Axon
2   Cambridge Skull Base Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Robert Macfarlane
3   Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
› Author Affiliations Funding None.
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Abstract

Spontaneous intracranial hypotension describes the clinical syndrome brought on by a cerebrospinal fluid (CSF) leak. Orthostatic headache is the key symptom, but others include nausea, vomiting, and dizziness, as well as cognitive and mood disturbance. In severe cases, the brain slumps inside the cranium and subdural collections develop to replace lost CSF volume. Initial treatment is by bed rest, but when conservative measures fail, attention is focused on finding and plugging the leak, although this can be very difficult and some patients remain bedbound for months or years. Recently, we have proposed an alternative approach in which obstruction to cranial venous outflow would be regarded as the driving force behind a chronic elevation of CSF pressure, which eventually causes dural rupture. Instead of focusing on the site of rupture, therefore, investigation and treatment can be directed at locating and relieving the obstructing venous lesion, allowing intracranial pressure to fall, and the dural defect to heal. The case we describe illustrates this idea. Moreover, since there was a graded clinical response to successive interventions relieving venous obstruction, and eventual complete resolution, it also provides an opportunity to consider particular symptoms in relation to cerebral venous insufficiency in its own right.

Keywords

Spontaneous intracranial hypotension - cerebrospinal fluid leak - idiopathic intracranial hypertension - cranial venous outflow obstruction - jugular stenosis - jugular venoplasty - styloidectomy - C1 transverse process resection


Publication History

Received: 10 July 2020

Accepted: 28 October 2020

Article published online:
31 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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