Modern approaches and diagnostic tools in neurosurgical practice: a case of patient with intracranial hypotension and secondary cervical spine degeneration
A. L. Krivoshapkin,
I. D. Savitskiy,
A. S. Gaytan,
I. A. Krotenkova,
G. S. Sergeev,
O. A. Abdullaev,
E. Chesnulis https://doi.org/10.15372/SSMJ20200306
Abstract
We report a case of a 47-years old woman presented to our department with the diagnosis of Chiari I malformation and extensive hydrosyringomyelia. Her main complains were severe headache and chronic pain syndrome in the left side of her breast and left arm. Magnetic resonance imaging (MRI) showed alterations suggestive of the presence of intracranial hypotension (IH), that was confirmed by measurement of cerebrospinal fluid (CSF) opening pressure and then CSF venous fistula was detected by computed tomography myelography (CTM). She was successfully surgically treated which leaded to the regression of the clinical symptoms and radiological alterations. Nevertheless, during her recovery after surgery she had an episode of recurrent left arm pain, which was interpreted as secondary cervical spine degeneration consequence. MRI confirmed C5-C6 disc herniation and transforaminal epidural injection of local anesthetic and corticosteroid solutions was performed. A week later she already felt significant improvement as her pain syndrome regressed a lot. IH should be considered in the differential diagnosis of headache and sagging brainstem and tonsils with cord syrinx on MRI and should not be misinterpreted as Chiari malformation. At the same time, transforaminal epidural injection appears to be an effective tool in modern neurosurgical practice allowing to determine the reason and accurate radiculopathy level.
About the Authors
A. L. Krivoshapkin
Novosibirsk State Medical University of Minzdrav of Russia; European Medical Center
Russian Federation
Russian Federation
Alexey L. Krivoshapkin, doctor of medical sciences, professor, corresponding member of RAS
630091, Novosibirsk, Krasny av., 52
129090, Moscow, Shchepkina str., 35
I. D. Savitskiy
Novosibirsk State Medical University of Minzdrav of Russia; European Medical Center
Russian Federation
Russian Federation
Igor D. Savitskiy
630091, Novosibirsk, Krasny av., 52
129090, Moscow, Shchepkina str., 35
A. S. Gaytan
Novosibirsk State Medical University of Minzdrav of Russia; European Medical Center
Russian Federation
Russian Federation
Alexey S. Gaytan, candidate of medical sciences
630091, Novosibirsk, Krasny av., 52
129090, Moscow, Shchepkina str., 35
I. A. Krotenkova
European Medical Center; Radiology Department, Research Center of Neurology
Russian Federation
Russian Federation
Irina A. Krotenkova, candidate of medical sciences
129090, Moscow, Shchepkina str., 35
125367, Moscow, Volokolamskoye hwy., 80
G. S. Sergeev
European Medical Center
Russian Federation
Russian Federation
Gleb S. Sergeev, candidate of medical sciences
129090, Moscow, Shchepkina str., 35
O. A. Abdullaev
Novosibirsk State Medical University of Minzdrav of Russia; European Medical Center
Russian Federation
Russian Federation
Orkhan A. Abdullaev
630091, Novosibirsk, Krasny av., 52
129090, Moscow, Shchepkina str., 35
E. Chesnulis
European Medical Center
Russian Federation
Evaldas Chesnulis129090, Moscow, Shchepkina str., 35
Russian Federation
Evaldas Chesnulis129090, Moscow, Shchepkina str., 35
References
1. Chiapparini L., Saletti V., Solero C.L., Bruzzone M.G., Valentini L.G. Neuroradiological diagnosis of Chiari malformations. Neurol. Sci. 2011; 32 (Suppl. 3): 283–286. doi: 10.1007/s10072-011-0695-0
2. Kranz P.G., Luetmer P.H., Diehn F.E., Amrhein T.J., Tanpitukpongse T.P., Gray L. Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension. Am. J. Roentgenol. 2016; 206 (1): 8–19. doi: 10.2214/AJR.15.14884
3. Kranz P.G., Amrhein T.J., Choudhury K.R., Tanpitukpongse T.P., Gray L. Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension. Am. J. Roentgenol. 2016; 207: 1283–1287. doi: 10.2214/AJR.16.16381
4. Michali-Stolarska M., Bladowska J., Stolarski M., Sąsiadek M.J. Diagnostic imaging and clinical features of intracranial hypotension – review of literature. Pol. J. Radiol. 2017; 82: 842–849. doi: 10.12659/PJR.904433
5. Mokri B. The Monro – Kellie hypothesis. Applications in CSF volume depletion. Neurology. 2001; 56 (12): 1746–1748. doi: 10.1212/wnl.56.12.1746
6. Schievink W.I. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006; 295 (19): 2286–2296. doi: 10.1001/jama.295.19.2286
7. Schievink W.I., Moser F.G., Maya M.M. CSF-venous fistula in spontaneous intracranial hypotension. Neurology. 2014; 83 (5), 472–473. doi: 10.1212/WNL.0000000000000639
Review
For citations:
Krivoshapkin A.L., Savitskiy I.D., Gaytan A.S., Krotenkova I.A., Sergeev G.S., Abdullaev O.A., Chesnulis E. Modern approaches and diagnostic tools in neurosurgical practice: a case of patient with intracranial hypotension and secondary cervical spine degeneration. Сибирский научный медицинский журнал. 2020;40(3):41-49. (In Russ.) https://doi.org/10.15372/SSMJ20200306
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