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J Neurol Surg Rep 2015; 76(01): e188-e193
DOI: 10.1055/s-0035-1555015
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Brain Slump Caused by Jugular Venous Stenoses Treated by Stenting: A Hypothesis to Link Spontaneous Intracranial Hypotension with Idiopathic Intracranial Hypertension

Nicholas Higgins
1   Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Rikin Trivedi
2   Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Richard Greenwood
3   National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
,
John Pickard
4   Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
› Author Affiliations
Further Information

Publication History

16 January 2015

29 April 2015

Publication Date:
12 June 2015 (online)

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Abstract

Spontaneous intracranial hypotension, of which brain slump is an extreme expression, is caused by a cerebrospinal fluid leak. The reason the leak develops in the first place, however, is unknown, and some cases can be very difficult to manage. We describe a patient with severe symptoms of spontaneous intracranial hypotension and brain slump documented by magnetic resonance imaging whose clinical syndrome and structural brain anomaly resolved completely after treatment directed exclusively at improving cranial venous outflow. Diagnostics included computed tomography (CT) venography, catheter venography, and jugular venoplasty. CT venography showed narrowing of both internal jugular veins below the skull base. Catheter venography confirmed that these were associated with pressure gradients. Jugular venoplasty performed on two separate occasions as a clinical test gave temporary respite. Lasting remission (2 years of follow-up) was achieved by stenting the dominant internal jugular vein. These findings and this outcome suggest a mechanism for the development of spontaneous intracranial hypotension that would link it to idiopathic intracranial hypertension and have cranial venous outflow obstruction as the underlying cause.

Keywords

spontaneous intracranial hypotension - idiopathic intracranial hypertension - brain slump - cranial venous outflow obstruction - jugular venoplasty - jugular stenting
 

  • References

  • 1 Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain 1991; 114 (Pt 1A): 155-180
    PubMedGoogle Scholar
  • 2 Sussman JD, Sarkies N, Pickard JD. Benign intracranial hypertension. Pseudotumour cerebri: idiopathic intracranial hypertension. Adv Tech Stand Neurosurg 1998; 24: 261-305
    PubMedGoogle Scholar
  • 3 Mokri B. Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache 2013; 53 (7) 1034-1053
    CrossrefPubMedGoogle Scholar
  • 4 Mokri B. Intracranial hypertension after treatment of spontaneous cerebrospinal fluid leaks. Mayo Clin Proc 2002; 77 (11) 1241-1246
    CrossrefPubMedGoogle Scholar
  • 5 Schievink WI, Deline CR. Headache secondary to intracranial hypotension. Curr Pain Headache Rep 2014; 18 (11) 457
    CrossrefPubMedGoogle Scholar
  • 6 Urbach H. Intracranial hypotension: clinical presentation, imaging findings, and imaging-guided therapy. Curr Opin Neurol 2014; 27 (4) 414-424
    CrossrefPubMedGoogle Scholar
  • 7 Sencakova D, Mokri B, McClelland RL. The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 2001; 57 (10) 1921-1923
    CrossrefPubMedGoogle Scholar
  • 8 Sautter NB, Batra PS, Citardi MJ. Endoscopic management of sphenoid sinus cerebrospinal fluid leaks. Ann Otol Rhinol Laryngol 2008; 117 (1) 32-39
    CrossrefPubMedGoogle Scholar
  • 9 Mokri B, Aksamit AJ, Atkinson JL. Paradoxical postural headaches in cerebrospinal fluid leaks. Cephalalgia 2004; 24 (10) 883-887
    CrossrefPubMedGoogle Scholar
  • 10 Mokri B. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia—evolution of a concept. Mayo Clin Proc 1999; 74 (11) 1113-1123
    CrossrefPubMedGoogle Scholar
  • 11 Miyazawa K, Shiga Y, Hasegawa T , et al. CSF hypovolemia vs intracranial hypotension in “spontaneous intracranial hypotension syndrome”. Neurology 2003; 60 (6) 941-947
    CrossrefPubMedGoogle Scholar
  • 12 Rosenfeld E, Dotan G, Kimchi TJ, Kesler A. Spontaneous cerebrospinal fluid otorrhea and rhinorrhea in idiopathic intracranial hypertension patients. J Neuroophthalmol 2013; 33 (2) 113-116
    CrossrefPubMedGoogle Scholar
  • 13 Woodworth BA, Prince A, Chiu AG , et al. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg 2008; 138 (6) 715-720
    CrossrefPubMedGoogle Scholar
  • 14 Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (9) 629-808
    CrossrefPubMedGoogle Scholar
  • 15 Chumas PD, Armstrong DC, Drake JM , et al. Tonsillar herniation: the rule rather than the exception after lumboperitoneal shunting in the pediatric population. J Neurosurg 1993; 78 (4) 568-573
    CrossrefPubMedGoogle Scholar
  • 16 Johnston I, Jacobson E, Besser M. The acquired Chiari malformation and syringomyelia following spinal CSF drainage: a study of incidence and management. Acta Neurochir (Wien) 1998; 140 (5) 417-427 ; discussion 427–428
    CrossrefPubMedGoogle Scholar
  • 17 Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002; 59 (10) 1492-1495
    CrossrefPubMedGoogle Scholar
  • 18 King JO, Mitchell PJ, Thomson KR, Tress BM. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology 2002; 58 (1) 26-30
    CrossrefPubMedGoogle Scholar
  • 19 Dashti SR, Nakaji P, Hu YC , et al. Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report. Neurosurgery 2012; 70 (3) E795-E799
    CrossrefPubMedGoogle Scholar