Intracranial hypotension following multiple lumbar punctures

Case contributed by A.Prof Frank Gaillard

Presentation

Known metastatic choriocarcinoma. CT found small lesion.

Patient Data

Age: 35 Years
Gender: Female

A small haemorrhagic lesion is seen involving the central sulcus of the right hemisphere. 

The patient went on to have surgery.

HISTOLOGY

MICROSCOPIC DESCRIPTION: Paraffin sections show collections of markedly atypical cells within oedematous and haemorrhagic brain parenchyma. These have irregularly shaped enlarged hyperchromatic nuclei, some with multiple nuclei and a variable amount of pale and vacuolated cytoplasm. The tumour cells are AE1/3, CAM5.2, CK7, CK19 and EMA positive. They are BHCG, c-kit, PLAP, AFP, tyrosinase, GFAP, nestin and TTF-1 negative. The features are consistent with metastatic choriocarcinoma.

FINAL DIAGNOSIS: Metastatic choriocarcinoma.

MRI

MRI post intrathecal chemotherapy

Patient was receiving intrathecal methotrexate and developed postural headache (worse on standing).

MRI demonstrate typical appearances of intracranial hypotension with diffuse dural thickening and enhancement, small ventricles, enlarged pituitary and engorged intracranial veins and dural venous sinuses. 

Case Discussion

This case demonstrates typical appearances of intracranial hypotension, in this case due to repeated lumbar punctures. The patient was treated with an epidural blood patch and symptoms resolved. 

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Case information

rID: 42780
Case created: 8th Feb 2016
Last edited: 13th Feb 2016
Inclusion in quiz mode: Included

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