gms | German Medical Science

Objective: Intracranial hypotension is commonly caused by a spinal cerebrospinal fluid (CSF) leakage after lumbar puncture (spinal tap), an incidental defect of the dura or following a lumbar shunt procedure. We describe a rare case of spontaneous intracranial hypotension in a patient carrying a ventriculo-peritoneal-shunt.

Methods: A 25-year-old man with an infantile hydrocephalus and a symptomatic epilepsy treated by placement of an adjustable VP shunt in the third month of life, was admitted to the neurosurgical emergency room with an acute traumatic brain injury following an epileptic seizure. Computed tomography (CT) of the neurocranium showed a large left-sided hygroma with midline shift to the right. Despite gradually increasing the resistance of the shunt valve to the highest level, the left-hemispheric hygroma increased and an additional right-hemispheric hygroma occurred. The patient was dynamic and had headache in upright position. A holospinal magnetic resonance myelography was performed, showing a CSF leakage at level Th 6/7. A history of spinal trauma or intervention was excluded. The patient was treated by application of a fluoroscopy-guided blood patch at the site of the leakage.

Results: After the application of a blood patch, the cranial CT showed a continuous regression of both hygromas. The patient was discharged after full clinical recovery. A follow-up examination after one month revealed no positional headache anymore. The follow-up cranial CT presented a complete regression of the hygromas on both sides.

Conclusion: Progressive hygroma in a patient carrying an adjustable valve and a shunt assistant can be caused by a spinal CSF-leakage and should be part of the differential diagnosis. This case report outlines the clinical features of this condition, documents neuroradiological findings and demonstrates a successful treatment with a blood patch.