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Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report

INTRODUCTION: Vasospasm is the most common cause of complication after a subarachnoid hemorrhage and tremendous efforts have been made to prevent it. A subarachnoid clot is the cause of the vasospasm and dissolving and washing it out is considered to be the best practice. Cisternal irrigation with u...

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Autores principales: Ishida, Atsushi, Matsuo, Seigo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168990/
https://www.ncbi.nlm.nih.gov/pubmed/25223331
http://dx.doi.org/10.1186/1752-1947-8-308
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author Ishida, Atsushi
Matsuo, Seigo
author_facet Ishida, Atsushi
Matsuo, Seigo
author_sort Ishida, Atsushi
collection PubMed
description INTRODUCTION: Vasospasm is the most common cause of complication after a subarachnoid hemorrhage and tremendous efforts have been made to prevent it. A subarachnoid clot is the cause of the vasospasm and dissolving and washing it out is considered to be the best practice. Cisternal irrigation with urokinase and ascorbic acid has been widely used due to its proven effect. CASE PRESENTATION: A 60-year-old Japanese male presented with a severe headache was diagnosed with a subarachnoid hemorrhage and an immediate surgical obliteration was successfully performed. After clipping the aneurysm, a cisternal drainage tube was placed in the chiasmatic cistern. In order to clear the thick subarachnoid hemorrhage, a cisternal irrigation was performed. However, his consciousness deteriorated and his left pupil became dilated on the next day. A T1 sagittal magnetic resonance imaging scan showed an evidence of marked brain sagging with mild tonsillar descent. We continued intensive hydration and head-down positioning and the brain sagging was shown to have improved in the follow-up magnetic resonance imaging scan. CONCLUSIONS: We present a case in which our patient experienced brain sagging after a cisternal irrigation of a subarachnoid hemorrhage. A subdural hematoma and low intracranial pressure suggested intracranial hypotension. Sagittal magnetic resonance imaging images are useful to evaluate brain sagging and are shown sequentially here in our case report.
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spelling pubmed-41689902014-09-20 Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report Ishida, Atsushi Matsuo, Seigo J Med Case Rep Case Report INTRODUCTION: Vasospasm is the most common cause of complication after a subarachnoid hemorrhage and tremendous efforts have been made to prevent it. A subarachnoid clot is the cause of the vasospasm and dissolving and washing it out is considered to be the best practice. Cisternal irrigation with urokinase and ascorbic acid has been widely used due to its proven effect. CASE PRESENTATION: A 60-year-old Japanese male presented with a severe headache was diagnosed with a subarachnoid hemorrhage and an immediate surgical obliteration was successfully performed. After clipping the aneurysm, a cisternal drainage tube was placed in the chiasmatic cistern. In order to clear the thick subarachnoid hemorrhage, a cisternal irrigation was performed. However, his consciousness deteriorated and his left pupil became dilated on the next day. A T1 sagittal magnetic resonance imaging scan showed an evidence of marked brain sagging with mild tonsillar descent. We continued intensive hydration and head-down positioning and the brain sagging was shown to have improved in the follow-up magnetic resonance imaging scan. CONCLUSIONS: We present a case in which our patient experienced brain sagging after a cisternal irrigation of a subarachnoid hemorrhage. A subdural hematoma and low intracranial pressure suggested intracranial hypotension. Sagittal magnetic resonance imaging images are useful to evaluate brain sagging and are shown sequentially here in our case report. BioMed Central 2014-09-15 /pmc/articles/PMC4168990/ /pubmed/25223331 http://dx.doi.org/10.1186/1752-1947-8-308 Text en Copyright © 2014 Ishida and Matsuo; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Ishida, Atsushi
Matsuo, Seigo
Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report
title Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report
title_full Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report
title_fullStr Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report
title_full_unstemmed Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report
title_short Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report
title_sort intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168990/
https://www.ncbi.nlm.nih.gov/pubmed/25223331
http://dx.doi.org/10.1186/1752-1947-8-308
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AT matsuoseigo intracranialhypotensioncausedbycisternalirrigationforvasospasmaftersubarachnoidhemorrhageacasereport