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Cerebral Venous Thrombosis and Subdural Collection in a Comatose Patient: Do Not Forget Intracranial Hypotension. A Case Report
Author(s) -
Paris Diane,
Rousset David,
Bonneville Fabrice,
Fabre Nelly,
Faguer Stanislas,
HuguetRigal Françoise,
Larcher Claire,
Martin Charlotte,
Osinski Diane,
Gaussiat François,
Delamarre Louis,
Brauge David,
Fourcade Olivier,
Geeraerts Thomas,
Mrozek Ségolène
Publication year - 2020
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13977
Subject(s) - medicine , subdural hemorrhage , coma (optics) , headaches , venous thrombosis , intracerebral hemorrhage , neurological examination , magnetic resonance imaging , anesthesia , presentation (obstetrics) , glasgow coma scale , thrombosis , radiology , surgery , hematoma , physics , optics
Background The typical sign of intracranial hypotension (IH) is postural headache. However, IH can be associated with a large diversity of clinical or radiological signs leading to difficult diagnosis especially in case of coma. The association of cerebral venous thrombosis (CVT) and subdural hemorrhage is rare but should suggest the diagnosis of IH. Methods Case report. Case Description We report here a case of comatose patient due to spontaneous IH complicated by CVT and subdural hemorrhage. The correct diagnosis was delayed due to many confounding factors. IH was suspected after subdural hemorrhage recurrence and confirmed by magnetic resonance imaging (MRI). After 2 epidural patches with colloid, favorable outcome was observed. Discussion The most common presentation of IH is postural orthostatic headaches. In the present case report, the major clinical signs were worsening of consciousness and coma, which are a rare presentation. Diagnosis of IH is based on the association of clinical history, evocative symptomatology, and cerebral imaging. CVT occurs in 1‐2% of IH cases and the association between IH, CVT, and subdural hemorrhage is rare. MRI is probably the key imaging examination. In the present case, epidural patch was performed after confounding factors for coma had been treated. Benefit of anticoagulation had to be balanced in this case with potential hemorrhagic complications, especially within the brain. Conclusion Association of CVT and subdural hemorrhage should lead to suspect IH. Brain imaging can help and find specific signs of IH.