ABSTRACT
A fístula liquórica para o osso temporal constitui um evento raro que decorre da comunicação anormal entre o espaço subaracnóideo e as células da mastoide, permitindo que o líquido cefalorraquidiano flua para as porções pneumatizadas do osso temporal. Tem como consequência a hipotensão intracraniana espontânea, caracterizada por perda de líquor e pela manifestação clínica de cefaleia ortostática. Acredita-se que a hipotensão intracraniana espontânea crie condições hemodinâmicas favoráveis à ocorrência de trombose venosa cerebral, uma desordem potencialmente fatal e de difícil diagnóstico, visto a inespecificidade de sinais clínicos e sintomas. Dessa forma, é pertinente atentar para a possibilidade de trombose venosa cerebral em pacientes com fístulas liquóricas, especialmente quando houver mudança do padrão da cefaleia, que passa de ortostática a intensa e contínua.
Temporal bone cerebrospinal fluid fistula is a rare event that results from abnormal communication between the subarachnoid space and the mastoid cells, allowing the cerebrospinal fluid to flow into the pneumatized portions of the temporal bone. It leads to spontaneous intracranial hypotension, characterized by loss of cerebrospinal fluid and orthostatic headache as a clinical manifestation. Spontaneous intracranial hypotension is believed to create favorable hemodynamic conditions to the occurrence of cerebral venous thrombosis, a potentially fatal disorder of difficult diagnosis given the nonspecific clinical signs and symptoms. Therefore, it is pertinent to consider the possibility of cerebral venous thrombosis in patients with cerebrospinal fluid fistulas, especially when there is a modification in the headache pattern from orthostatic to intense and continuous pain.
Subject(s)
Humans , Female , Adult , Cerebral Veins/physiopathology , Venous Thrombosis/physiopathology , Intracranial Hypotension/diagnosis , Fistula/diagnosis , Headache/complicationsABSTRACT
Spontaneous intracranial hypotension (SIH) is caused by single or multiple cerebrospinal fluid (CSF) leaks in the spine with the prototypical symptom of postural headache. One of the characteristic MRI features in SIH is intracranial venous engorgement. This report presents a case of SIH with engorgement of the bilateral superior ophthalmic veins (SOVs) which resume their normal diameters by the third day of successful epidural blood patches (EBPs). We define this phenomenon as the "reversal of the SOV" sign.
Subject(s)
Aged , Humans , Male , Blood Patch, Epidural , Cerebrospinal Fluid Rhinorrhea/complications , Diagnosis, Differential , Intracranial Hypotension/diagnosis , Magnetic Resonance Imaging , Orbit/blood supplyABSTRACT
El síndrome de hipotensión intracraneal espontánea constituye una entidad clínica cuya principal manifestaciónes la cefalea ortostática. Esta se acompaña de un descenso en la presión del líquido cefalorraquídeo (LCR) y un realce difuso de las paquimeninges evidenciable en la resonancia magnéticaencefálica, sin que medie historia de trauma craneoencefálico o punción lumbar. Mujer de 24 años de edad sinantecedentes de importancia y cefalea holocraneana de carácter opresivo de 15 días de evolución. La mismase exacerbaba con la bipedestación y cedía con el decúbito. En la punción lumbar se observó pleocitosis apredominio linfocítico, hiperproteinorraquia y abundantes glóbulos rojos, siendo la presión de apertura del LCR de 20 mm H2O. La resonancia magnética encefálica mostró un realce paquimeníngeo difuso luego de la administración del gadolinio. La cisternografía radioisotópica con tecnecio 99 señaló el sitio de pérdida de LCR a nivel dorsal alto, confirmándose la sospecha diagnóstica de hipotensión intracraneal espontánea. La pacienterecibió tratamiento médico conservador con evolución clínica favorable. Los hallazgos en los exámenes complementarios y las características clínicas de la cefalea, permitirán confirmar el diagnóstico de hipotensiónintracraneal espontánea, evitando de esta manera la realización de procedimientos innecesarios
Spontaneous intracranial hypotension is an infrequent clinical entity characterized by orthostatic headache, low cerebrospinal fluid pressure, and magnetic resonance imaging findings of diffuse pachymeningeal gadolinium enhancement without previous history of head trauma or lumbar puncture. A 24 year-old healthy woman was referred after having daily headaches for twoweeks. She described a headache that occurred soon after assuming an upright position and disappeared afterresuming a recumbent position. The cerebrospinal fluid showed pleocytosis primarily lymphocitic, raised proteincontent and an opening pressure of 20 mm H2O. Magnetic resonance imaging of the head showed diffuse pachymeningeal gadolinium enhancement. Radioisotope cisternography using 99mTc-DTPA confirmed the cerebrospinalfluid leak in the thoracic region. With conservative treatment the patient improved in a few days and theheadache disappeared. Radiological findings, together with a compatible clinical condition, help to establish thediagnosis of spontaneous intracranial hypotension and avoid the use of unnecessary clinical investigations
Subject(s)
Humans , Female , Adult , Cerebrospinal Fluid Pressure , Intracranial Hypotension/cerebrospinal fluid , Brain/pathology , Chelating Agents , Gadolinium , Headache/diagnosis , Headache/etiology , Intracranial Hypotension/diagnosis , Magnetic Resonance Imaging , Meninges , Posture/physiology , Tomography, X-Ray ComputedABSTRACT
Descrevemos o caso de um paciente de 45 anos de idade com cefaléia postural secundária a hipotensao liquórica espontânea, no qual a ressonância nuclear magnética do crânio revelou impregnaçao de contraste e espessamento meníngeo.