Peter Bernhard Sporns1, Sebastian Zimmer2, Uta Hanning2, Tarek Zoubi2, Johannes Wölfer3, Mirco Herbort4, Wolfram Schwindt2, Thomas Niederstadt2. 1. Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany. Electronic address: peter.sporns@ukmuenster.de. 2. Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany. 3. Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany. 4. Department of Trauma Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster 48149, Germany.
Abstract
BACKGROUND CONTEXT: Cases of cerebral hypotension and tonsillar herniation after accidental lumbar cerebrospinal fluid (CSF) drainage or chest tube drainage with intrathoracic CSF leaks have been reported. To the authors' knowledge, this case presents the first report of severe intracranial hypotension because of suction of CSF by a Vacuum-Assisted Closure (VAC) device. PURPOSE: The purpose of this study was to report a life-threatening intracranial hypotension in a polytraumatized patient after VAC therapy. STUDY DESIGN: This study is a case report. METHODS: A 23-year-old woman suffered of a Grade 3 open pelvic fracture after a motor vehicle accident. After a VAC therapy, the patient became nonresponsive. A cranial computer tomography (CCT) showed signs of intracranial hypotension with narrowing of the basal cisterns and sagging of the cerebellar tonsils. The VAC was removed. Further neuroradiological diagnostic showed a tear in the dural sac at the L5-S1 level. The patient consequently underwent neurosurgery. After a dural patch, she was oriented postoperatively and the CCT improved to a normal state. RESULTS: Fifteen days after admission, the patient was discharged without neurologic sequelae. CONCLUSIONS: Severely injured patients undergoing VAC therapy with secondary neurologic deterioration not because of head injury should be appropriately diagnosed to rule out dural laceration and cranial hypotension.
BACKGROUND CONTEXT: Cases of cerebral hypotension and tonsillar herniation after accidental lumbar cerebrospinal fluid (CSF) drainage or chest tube drainage with intrathoracic CSF leaks have been reported. To the authors' knowledge, this case presents the first report of severe intracranial hypotension because of suction of CSF by a Vacuum-Assisted Closure (VAC) device. PURPOSE: The purpose of this study was to report a life-threatening intracranial hypotension in a polytraumatized patient after VAC therapy. STUDY DESIGN: This study is a case report. METHODS: A 23-year-old woman suffered of a Grade 3 open pelvic fracture after a motor vehicle accident. After a VAC therapy, the patient became nonresponsive. A cranial computer tomography (CCT) showed signs of intracranial hypotension with narrowing of the basal cisterns and sagging of the cerebellar tonsils. The VAC was removed. Further neuroradiological diagnostic showed a tear in the dural sac at the L5-S1 level. The patient consequently underwent neurosurgery. After a dural patch, she was oriented postoperatively and the CCT improved to a normal state. RESULTS: Fifteen days after admission, the patient was discharged without neurologic sequelae. CONCLUSIONS: Severely injured patients undergoing VAC therapy with secondary neurologic deterioration not because of head injury should be appropriately diagnosed to rule out dural laceration and cranial hypotension.
Authors: Christian Herren; Rolf Sobottke; Anne F Mannion; Thomas Zweig; Everard Munting; Philippe Otten; Tim Pigott; Jan Siewe; Emin Aghayev Journal: Eur Spine J Date: 2017-06-20 Impact factor: 3.134