Intracranial hypotension

Case contributed by Dr Andrew Lawson

Presentation

Complex neurosurgical history, but a good example of a complication from a VP shunt.

Patient Data

Age: 80
Gender: Female
Modality: MRI

A left occipital craniectomy is noted extending to the left foramen Magnum and through the posterior wall of the mastoid air cells. Small amount of fluid is present in the posterior mastoid air cells. No fluid signal identified in the middle ear cavities. Mild asymmetric left cerebellar hemisphere atrophy is noted. A focal region of encephalomalacia is visible in the right cerebellar hemisphere in keeping with a small old infarct. No regions of restricted diffusion allowing for some artifact near the bone interface. Right occipital intraventricular drain noted with an associated almost slitlike appearance to the lateral ventricles, right more than left. The midline is shifted 4mm to the right. The temporal horns and 4th ventricle are normal. Bilateral fronto-parieto-occipital subdural hygromas noted, left greater than right ( 6 mm and 3 mm respectively). Avid and smooth dural enhancement and thickening throughout the brain. On the sagittal imaging marked crowding of the posterior fossa at the level of the foramen Magnum is evident with sagging of the pons. 

Conclusion: Findings of intracranial hypotension, most likely relating to over shunting.

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Case Information

rID: 26096
Case created: 28th Nov 2013
Last edited: 13th Feb 2016
Inclusion in quiz mode: Included

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