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Cerebral venous infarction after epidural blood patch treatment in a patient with intracranial hypotension

Year 2014, Volume: 6 Issue: 1, 20 - 23, 01.04.2014

Abstract

Aim: Intracranial hypotension and epidural blood patch treatment for cerebrospinal fluid leakage can cause a variety of neurological complications. Herein, we aimed to describe a case of cerebral venous thrombosis as a rare complication. Case Report: Forty-six year old female underwent open laminectomy at L4 level for disc herniation. After surgery, local anesthetic and corticosteroid injection was done for persistent back and extremity pain. After the procedure, severe orthostatic headache was developed. Despite brain magnetic resonance imaging MRI was found in normal limits, the diagnosis of intracranial hypotension was established with the clinical findings. Epidural blood patch application with 5cc venous blood was done for peristant headache which made her headache free. Two days after the procedure, she became unconcious and started having epileptic seizures. Brain MRI showed ischemia in bilateral frontal regions. MR venography showed total occlusion at sagittal superior venous sinus. Coagulation tests were found within normal limits. Anticoagulant and anti-oedematous medications was started. Her neurological findings were resolved at the end of first month. Conclusion: We report here the first case of cerebral venous infarction caused by intracranial hypotension and epidural blood patch treatment after lumbar disc surgery. This serious complication should be considered in patients with intracranial hypotention who require epidural blood patch treatment

References

  • Bushnell C, Saposnik G. Evaluation and man- agement of cerebral venous thrombosis. Con- tinuum (Minneap Minn) 2014;20(2 Cerebrovas- cular Disease):335-351.
  • Wulf HF. The centennial of spinal anesthesia. Anesthesiology 1998; 89: 500–506.
  • Tarkkila PJ, Miralles JA, Palomaki EA. The subjective complications and efficiency of the epidural blood patch in the treatment of postdural puncture headache. Reg Anesth 1989;14(5):247-50.
  • Coutinho JM, Gerritsma JJ, Zuurbier SM, Stam J. Isolated cortical vein thrombosis: systematic review of case reports and case series. Stroke 2014; 17: [Epub ahead of print].
  • Ö Kamışlı, D Arslan, S Altınayar, S Kamışlı, Y Kablan, C Özcan ve ark. Serebral venöz sinüs trombozu: klinik değerlendirme. Türk Serebro- vasküler Hastalıklar Dergisi 2009 15:2; 39-42.
  • Schievink WI, Maya MM. Cerebral venous thrombosis in spontaneous intracranial hypo- tension. Headache 2008; 48(10):1511–1519.
  • Yoon KW, Cho MK, Kim YJ, Cho CS, Lee SK. Sinus thrombosis in a patient with ıntracranial hypotension: a suggested hypothesis of venous stasis. Interv Neuroradiol 2011; 17(2): 248–251.
  • Kinney MO, McCarron MO. Intracranial hy- potension and venous sinus thrombosis: two postpartum headaches. Postgrad Med J 2011;87(1030): 571–572.
  • Laverse E, Cader S, Silva R, Chawda S, Kapoor S, Thompson O. Peripartum ısolated cortical vein thrombosis in a mother with postdural punc- ture headache treated with an epidural blood patch. Case Reports in Medicine 2013 ;1-3.

İntrakranyal hipotansiyon olgusunda epidural kan yaması tedavisi sonrası gelişen serebral venöz infarkt

Year 2014, Volume: 6 Issue: 1, 20 - 23, 01.04.2014

Abstract

Amaç: Epidural kan yaması tedavisi, intrakranyal hipotansiyon olgularında çeşitli nörolojik komplikasyonlara neden olabilir. Burada nadir bir komplikasyon olarak serebral venöz tromboz olgusu tanımlanmıştır. Olgu Sunumu: Kırk altı yaşındaki kadın hastaya L4 seviyesinde disk hernisine yönelik laminektomi yapıldı. Operasyondan on beş gün sonra, ağrısı devam eden hastanın lomber L4 kök bölgesine lokal anestezik ve kortikosteroid enjeksiyonu yapıldı. İşlemden sonra şiddetli ortostatik baş ağrısı gelişen hastaya, beyin omurilik sıvısı kaçağına bağlı intrakranyal hipotansiyon tanısı konulmuşdu. Konservatif tedaviden yarar görmeyen hastaya 5cc venöz kan ile epidural kan yaması yapıldı. İşlemden 2 gün sonra hastada şuur bozukluğu ve epileptik nöbetler başladı. Beyin MRG incelemesinde bilateral frontal bölgelerde venöz infarktla uyumlu görünüm saptandı. MR venografi incelemesinde sagittal venöz sinüsün tromboze olduğu görüldü. Koagülasyon testleri normal sınırlarda bulundu. Antikoagülan ve anti-ödem tedavi verildi. Hastanın nörolojik bulguları bir ay sonra tama yakın düzeldi. Tartışma: Lomber disk cerrahisini takiben gelişen intrakranyal hipotansiyon ve epidural kan yaması tedavisi sonrası gelişen serebral venöz infarkt literatürde ilk kez tarafımızca rapor edilmektedir. Bu ciddi komplikasyon, olguların takibinde göz önünde bulundurulmalıdır.

References

  • Bushnell C, Saposnik G. Evaluation and man- agement of cerebral venous thrombosis. Con- tinuum (Minneap Minn) 2014;20(2 Cerebrovas- cular Disease):335-351.
  • Wulf HF. The centennial of spinal anesthesia. Anesthesiology 1998; 89: 500–506.
  • Tarkkila PJ, Miralles JA, Palomaki EA. The subjective complications and efficiency of the epidural blood patch in the treatment of postdural puncture headache. Reg Anesth 1989;14(5):247-50.
  • Coutinho JM, Gerritsma JJ, Zuurbier SM, Stam J. Isolated cortical vein thrombosis: systematic review of case reports and case series. Stroke 2014; 17: [Epub ahead of print].
  • Ö Kamışlı, D Arslan, S Altınayar, S Kamışlı, Y Kablan, C Özcan ve ark. Serebral venöz sinüs trombozu: klinik değerlendirme. Türk Serebro- vasküler Hastalıklar Dergisi 2009 15:2; 39-42.
  • Schievink WI, Maya MM. Cerebral venous thrombosis in spontaneous intracranial hypo- tension. Headache 2008; 48(10):1511–1519.
  • Yoon KW, Cho MK, Kim YJ, Cho CS, Lee SK. Sinus thrombosis in a patient with ıntracranial hypotension: a suggested hypothesis of venous stasis. Interv Neuroradiol 2011; 17(2): 248–251.
  • Kinney MO, McCarron MO. Intracranial hy- potension and venous sinus thrombosis: two postpartum headaches. Postgrad Med J 2011;87(1030): 571–572.
  • Laverse E, Cader S, Silva R, Chawda S, Kapoor S, Thompson O. Peripartum ısolated cortical vein thrombosis in a mother with postdural punc- ture headache treated with an epidural blood patch. Case Reports in Medicine 2013 ;1-3.
There are 9 citations in total.

Details

Primary Language Turkish
Journal Section Case Report
Authors

M. Ayşen Çakmak This is me

Şevki Şahin This is me

Nilgün Çınar This is me

Bilal Kelten This is me

Sibel Karşıdağ This is me

Publication Date April 1, 2014
Published in Issue Year 2014 Volume: 6 Issue: 1

Cite

Vancouver Çakmak MA, Şahin Ş, Çınar N, Kelten B, Karşıdağ S. İntrakranyal hipotansiyon olgusunda epidural kan yaması tedavisi sonrası gelişen serebral venöz infarkt. Maltepe tıp derg. 2014;6(1):20-3.