Case Report
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World J Clin Cases. Dec 16, 2013; 1(9): 295-297
Published online Dec 16, 2013. doi: 10.12998/wjcc.v1.i9.295
Intracranial hypotension syndrome in a patient due to suboccipital craniectomy secondary to Chiari type malformation
Dora Barkoula, Nikolaos Bontozoglou, Stylianos Gatzonis, Damianos Sakas
Dora Barkoula, Department of Neurology, “Agioi Anargiroi” Hospital, 14564 Athens, Greece
Nikolaos Bontozoglou, Radiology and CT–Scanning Unit, Athens Medical Centre, 15125 Athens, Greece
Stylianos Gatzonis, Epilepsy Surgery Unit, Medical School, University of Athens, 11527 Athens, Greece
Stylianos Gatzonis, Sakas Damianos, Department of Neurosurgery, Evangelismos Hospital, 10676 Athens, Greece
Damianos Sakas, Hellenic Center of Neurosurgical Research, University of Athens, 11527 Athens, Greece
Author contributions: Gatzonis S participated in data acquisition, analyzed and interpreted the patient data regarding the clinical picture and treatment options and corrected the final version of this manuscript; Bontozoglou N participated in data acquisition, analyzed and interpreted the patient data regarding the radiological imaging and corrected the final version of this manuscript; Barkoula D participated in data acquisition, analysis and interpretation of data and was a major contributor in writing the manuscript; Sakas D conceived and coordinated this study and participated in the interpretation of data; all authors contributed in conception, design and drafting the article, read and approved the final manuscript.
Correspondence to: Dora Barkoula, MD, Department of Neurology, "Agioi Anargiroi" Hospital, 23 Zinonos St., 15234 Athens, Greece. dora.bark@gmail.com
Telephone: +30-210-6818380 Fax: +30-210-6818380
Received: September 17, 2013
Revised: October 29, 2013
Accepted: November 18, 2013
Published online: December 16, 2013
Processing time: 86 Days and 20.9 Hours
Abstract

Intracranial hypotension syndrome (IHS) is a rare disorder characterized by a decrease in cerebrospinal fluid pressure to less than 60 mm H2O. The syndrome is associated with occipital headache radiating to the frontal and temporal zones. The current clinical case describes the manifestation of IHS in a twenty-five year old female with a history of suboccipital craniectomy due to Chiari I malformation nine years earlier. The patient was admitted to the hospital complaining about postural, mainly occipital, headache during the last three months, aggravated by being in an upright position. The magnetic resonance imaging (MRI) revealed engorgement of the dural venous sinuses, significant enlargement of the pituitary gland and download displacement or sagging of the brain with effacement of the perichiasmatic cisterns and the prepontine cistern, while the spinal T2W MRI revealed a 7 mm × 2.5 mm dural defect with an extradural cerebrospinal fluid collection at the dorsal soft tissues of the cervical spine. The previous imaging did not reveal subdural effusions.

Keywords: Headache; Craniectomy; Cerebrospinal fluid; Intracranial hypotension syndrome; Effusion; Chiari

Core tip: A 25-year-old female presented with a history of suboccipital craniectomy due to Chiari I malformation nine years earlier. The patient was admitted to the hospital with symptoms of postural, mainly occipital, headache during the last three months, aggravated by being in an upright position. The spinal T2W magnetic resonance imaging revealed a 7 mm × 2.5 mm dural defect with an extradural cerebrospinal fluid collection at the dorsal soft tissues of the cervical spine. The current clinical case indicates that a longer follow-up and increased alertness are required in a patient with a history of craniectomy due to Chiari I malformation.