Titre
Brain stem and cerebellar dysfunction after lumbar spinal fluid drainage: case report
Type
étude de cas
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Auteur(s)
Bloch, J.
Auteure/Auteur
Regli, L.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
0022-3050
Statut éditorial
Publié
Date de publication
2003-07
Volume
74
Numéro
7
Première page
992
Dernière page/numéro d’article
4
Peer-reviewed
Oui
Notes
Case Reports
Journal Article --- Old month value: Jul
Journal Article --- Old month value: Jul
Résumé
Lumbar spinal fluid drainage is a common procedure to reduce the risks of cerebrospinal fluid (CSF) fistula after skull base fractures or various transdural neurosurgical procedures. Nevertheless, this simple and effective technique can lead to overdrainage and CSF hypovolaemia. This report describes the case of a young patient who had a lumbar drain inserted, to avoid CSF fistula after a pterional craniotomy with opening of the frontal sinus for the clipping of a ruptured aneurysm. The drain was removed after 48 hours because of underdrainage (<1 ml/h). Three days after drain removal, she developed rapid deterioration of her level of consciousness and signs of cranial nerves involvement, brain stem and cerebellar dysfunction. Intracranial pressure was low (<5 cm H(2)O) and MRI showed brain sagging and cerebellar foramen magnum herniation. The patient was successfully treated with epidural blood patch, ventricular drainage, and Trendelenburg position. The authors report this case because CSF hypovolaemia attributable to lumbar overdrainage is an insidious and threatening condition not easy to diagnose in the absence of detectable CSF leak. MRI and intracranial pressure monitoring confirm the diagnosis and permit better understanding of the physiopathology of brain sagging.
Sujets
PID Serval
serval:BIB_85967C2B1C38
PMID
Open Access
Oui
Date de création
2008-02-06T09:03:08.034Z
Date de création dans IRIS
2025-05-20T22:28:44Z