ABSTRACT
A 63-year-old woman presented with headache, progressive somnolence, neurocognitive decline and urinary incontinence through a year. Medical history was unremarkable except for hypertension and hypercholesterolaemia. Neurological examination was normal. Brain MRI showed findings typical for spontaneous intracranial hypotension (subdural fluid collection, pachymeningeal enhancement, brain sagging) and pituitary tumour. The patient's complaints improved dramatically but temporarily after treatment with each of repeated targeted as well as non-targeted blood patches and a trial with continuous intrathecal saline infusion. Extensive work up including repeated MRI-scans, radioisotope cisternographies, CT and T2-weighted MR myelography could not localise the leakage, but showed minor root-cysts at three levels. Finally, lateral decubitus digital subtraction dynamic myelography with subsequent CT myelography identified a tiny dural venous fistula at the fourth thoracic level. After surgical venous ligation, the patient fully recovered. Awareness of spontaneous dural leaks and their heterogeneous clinical picture are important and demands an extensive workup.
Subject(s)
Cognitive Dysfunction , Intracranial Hypotension , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Female , Humans , Intracranial Hypotension/diagnosis , Intracranial Hypotension/diagnostic imaging , Magnetic Resonance Imaging , Middle Aged , Myelography , NeuroimagingABSTRACT
Spontaneous intracranial hypotension (SIH) is a secondary headache disorder due to leakage of cerebrospinal fluid without a history of dural trauma. If not diagnosed in time, patients may develop invalidating headaches or even life-threatening complications. SIH diagnosis can be challenging as the presentation of the disease may vary significantly. In this case report of a classic course of disease in a 62-year-old woman, we illustrate challenges according to the diagnosis emphasising the importance to consider SIH as a differential diagnosis in cases of orthostatic but also atypical chronic headache.
Subject(s)
Headache Disorders , Intracranial Hypotension , Diagnosis, Differential , Female , Headache/diagnosis , Headache/etiology , Headache Disorders/diagnostic imaging , Headache Disorders/etiology , Humans , Intracranial Hypotension/diagnosis , Intracranial Hypotension/diagnostic imaging , Magnetic Resonance Imaging , Middle AgedABSTRACT
Alien hand syndrome (AHS) is a rare condition, which is defined as involuntary meaningful movements of a limb associated with loss of ownership over the limb. It affects mostly the left hand. Corticobasal degeneration, stroke and Creutzfeldt-Jakob disease are the three leading causes of AHS. AHS is classically divided into three subcategories: frontal, callosal and posterior. Loss of inhibitory tone and loss of bilateral hemisphere activation are the hypothesised pathophysiologic causes of AHS. This is a case report of a posterior AHS in a 47-year-old woman after stroke in the right parietal lobe.
