Asian Journal of Neurosurgery

CASE REPORT
Year
: 2019  |  Volume : 14  |  Issue : 1  |  Page : 219--222

Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient


Keita Mayanagi, Masashi Nakatsukasa, Joji Inamasu 
 Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan

Correspondence Address:
Dr. Joji Inamasu
Department of Neurosurgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya 321-0974
Japan

We present a rare case of traumatic acute subdural hematoma (SDH) in which intracranial hypotension (IC) secondary to cerebrospinal fluid (CSF) leakage at the lumbar spine caused delayed neurological deterioration. A 70-year-old male sustained a head injury after ground-level fall and was brought to our institution. A brain computed tomography (CT) showed a thin acute SDH with mild brain shift, and conservative management was initiated. He exhibited neurological deterioration on the 9th hospital day, however, and a brain CT showed a change in CT density and marked an increase in hematoma volume and brain shift. It was thought that conversion from acute to subacute SDH was associated with the deterioration, and emergency hematoma evacuation was performed. Despite the surgery, neither clinical nor radiographical improvement occurred. The lack of improvement pointed to the presence of underlying IC, and a CT myelography revealed the dural sleeve of the right L2 nerve root as the source of the CSF leakage. An epidural blood patch therapy was performed on the 12th hospital day to seal the CSF leakage. The postprocedural course was uneventful, and the patient was discharged free of symptoms on the 20th hospital day. Spinal CSF leakage should be considered as a cause of delayed neurological deterioration in patients with traumatic acute SDH which exhibits conversion to subacute SDH.


How to cite this article:
Mayanagi K, Nakatsukasa M, Inamasu J. Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient.Asian J Neurosurg 2019;14:219-222


How to cite this URL:
Mayanagi K, Nakatsukasa M, Inamasu J. Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient. Asian J Neurosurg [serial online] 2019 [cited 2019 Sep 18 ];14:219-222
Available from: http://www.asianjns.org/article.asp?issn=1793-5482;year=2019;volume=14;issue=1;spage=219;epage=222;aulast=Mayanagi;type=0