Subject(s)
Encephalocele/complications , Meningocele/diagnostic imaging , Petrous Bone/diagnostic imaging , Subarachnoid Space/diagnostic imaging , Trigeminal Neuralgia/etiology , Aged , Diagnosis, Differential , Encephalocele/diagnostic imaging , Female , Humans , Image Interpretation, Computer-Assisted , Magnetic Resonance Imaging , Tomography, Spiral Computed , Tomography, X-Ray Computed , Trigeminal Neuralgia/diagnostic imagingABSTRACT
PURPOSE: Intracranial hypotension has been reported as a complication of accidental drainage after surgical treatment in several cases. Application of negative pressure systems (wound drains, VAC(®)-therapy, chest tube drainage) had typically led to severe intracranial hypotension including intracranial hemorrhage and tonsillar herniation. In the last year the authors observed 2 cases of accidental spinal drainage of CSF in patients with neurological deficits, regressing after reduction of the device suction. MATERIAL AND METHODS: We conducted a systematic PubMed-based research of the literature to study the variety and frequency of the reported symptoms from 1st of January 1980 until 1st of October 2015. RESULTS: Reviewing the literature 24 relevant citations including 27 reported cases of posttraumatic or postoperative loss of CSF leading to neurological symptoms were identified. All 15 reported cases in which a negative pressure suction device had been applied showed severe neurological and radiological symptoms such as coma or brain herniation and intracranial hemorrhage. In all cases patients recovered rapidly after removal of the suction device. Milder symptoms were observed in the patients without negative pressure suction, mainly only presenting with headaches or cranial nerve involvement.Additionally, we give an overview about current recommendations regarding cranial and spinal imaging to rule out dural laceration and cranial hypotension. CONCLUSION: Patients with dural laceration complicated by accidental drainage of CSF can present with life-threatening conditions. Increasing use of negative pressure suction devices makes the reported condition an important differential diagnosis. A precise radiological examination can help to rule out dural laceration and intracranial hypotension. KEY POINTS: â¢âUndetected dural laceration complicated by negative pressure suction drains can induce life-threatening symptoms.â¢âIncreasing use of negative pressure suction devices makes the reported condition an important differential diagnosis for radiologists Citation Format: â¢âSporns PB, Schwindt W, Cnyrim CD etâal. Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits. Fortschr Röntgenstr 2016; 188: 451â-â458.
Subject(s)
Brain Damage, Chronic/etiology , Cerebrospinal Fluid Leak/epidemiology , Cerebrospinal Fluid Leak/etiology , Cerebrospinal Fluid Shunts , Dura Mater/injuries , Intracranial Hypotension/etiology , Medical Errors , Suction/adverse effects , Brain Damage, Chronic/epidemiology , Cross-Sectional Studies , Humans , Intracranial Hypotension/epidemiology , Postoperative Care/adverse effectsSubject(s)
Diffusion Magnetic Resonance Imaging , Encephalocele/complications , Encephalocele/diagnosis , Magnetic Resonance Imaging , Petrous Bone/pathology , Trigeminal Neuralgia/diagnosis , Trigeminal Neuralgia/etiology , Contrast Media , Decompression, Surgical , Encephalocele/surgery , Gadolinium , Humans , Image Enhancement , Microsurgery , Trigeminal Nerve/pathology , Trigeminal Nerve/surgery , Trigeminal Neuralgia/surgeryABSTRACT
Acute unilateral peripheral and central vestibular lesions can cause similar signs and symptoms, but they require different diagnostics and management. We therefore correlated clinical signs to differentiate vestibular neuritis (40 patients) from central "vestibular pseudoneuritis" (43 patients) in the acute situation with the final diagnosis assessed by neuroimaging. Skew deviation was the only specific but non-sensitive (40%) sign for pseudoneuritis. None of the other isolated signs (head thrust test, saccadic pursuit, gaze evoked nystagmus, subjective visual vertical) were reliable; however, multivariate logistic regression increased their sensitivity and specificity to 92%.
