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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 0028-3886
Vol. 54, No. 4, 2006, pp. 421-424
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Bioline Code: ni06144
Full paper language: English
Document type: Research Article
Document available free of charge
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Neurology India, Vol. 54, No. 4, 2006, pp. 421-424
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Case Report - Multiple simultaneous intracerebral hemorrhages following accidental massive lumbar cerebrospinal fluid drainage: Case report and literature review
Ruiz-Sandoval JoseL, Campos Ariel, Romero-Vargas Samuel, Jimenez-Rodriguez MariaI, Chiquete Erwin
Abstract
Multiple simultaneous intracerebral hemorrhages (ICH) are uncommon. We report the case of an 80-year-old woman with previous diagnosis of normal pressure hydrocephalus and who was brought to our hospital with altered mental status and urinary incontinence. Medical history of hypertension, hematological disorders or severe head trauma was absent. Platelet count and coagulation profile were unremarkable. An initial head computed tomography (CT) showed sulcal enlargement and ventricular dilatation, but no evidence of ICH. A tap test indicated as a guide to case selection for shunt surgery accidentally resulted in cerebrospinal fluid (CSF) overdrainage. The patient presented sudden neurological deterioration, with sluggishly responsive pupils and generalized tonic-clonic seizures. A new head CT demonstrated multiple supra and infratentorial ICH. The patient became comatose and had a fatal course. Hence, CSF overdrainage may either cause or precipitate multiple simultaneous ICHs, affecting both the infratentorial and supratentorial regions.
Keywords
Cerebrospinal fluid, intracranial hemorrhage, intracranial hypotension, lumbar drainage, neurological examination
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