KAZUISTIKA / CASE REPORT Intracranial hypotension in a young male patient associated with shoulder injury | 247 / Anest intenziv Med. 2024;35(4):245-247 / ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA www.aimjournal.cz we performed CT perimyelography which showed subtle CSF leakage at the levels of avulsions. Treatment of intracranial hypotension ranges from conservative management, such as bed rest, overhydration, mild hypertension, and caffeine, to invasive procedures. Most patients are successfully treated conservatively. Among invasive procedures, a blood patch is one of the most common interventions [3]. Urgent management may include positioning the patient in the Trendelenburg position [4]. In our case, the CSF leakage ceased after positioning. In conclusion, our case demonstrates the importance of being aware of the trauma and IH association, even in the absence of head or spinal trauma. Moreover, several lessons should be learned from this case. First, diagnosing intracranial hypotension is challenging due to the absence of pathognomonic signs on standard CT scans; therefore, additional tests such as perimyelography need to be employed. Second, a negative or very low intracranial pressure should always lead to considering the presence of intracranial hypotension due to cerebrospinal fluid leakage as a possible cause of coma. And third, it is crucial to move the patient with known or suspected CSF leakage from the standard semirecumbent position to the supine position or, in urgent situations, to the Trendelenburg position. Conclusion Intracranial hypotension is a relatively rare, but clinically significant finding that may affect the final clinical outcome. We should always consider its presence in patients where there is no other, clinically more relevant explanation for the deterioration of consciousness. Written consent for publication was obtained from the patient PROHLÁŠENÍ AUTORŮ: Prohlášení o použití AI: Autoři prohlašují, že při psaní tohoto odborného článku nepoužili žádnou formu umělé inteligence. Všechny informace a analýzy jsou výsledkem jejich vlastního výzkumu, zkušeností a úsudku s důrazem na relevantní literaturu, primární zdroje a konzultace s odborníky v oboru. Prohlášení o původnosti: Práce je původní a nebyla publikována ani není zaslána k recenznímu řízení do jiného média. Střet zájmů: Autoři prohlašují, že nemají střet zájmů v souvislosti s tématem práce. Podíl autorů: Všichni autoři rukopis četli, souhlasí s jeho zněním a zasláním do redakce časopisu Anesteziologie a intenzivní medicína. MK se podílel na psaní článku i ideové náplni článku. Financování: žádné. Poděkování: N/A. Registrace: N/A. Projednání etickou komisí: N/A. Zařazení do rubriky časopisu: kazuistika. REFERENCES 1. Albes G, Weng H, Horvath D, Musahl C, Bäzner H, Henkes H. Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension. Neuroradiology. 2012 Dec 1;54(12):1367-73. doi: 10.1007/s00234-012-1055-3. 2. Berroir S, Loisel B, Ducros A, Boukobza M, Tzourio C, Valade D, et al. Early epidural blood patch in spontaneous intracranial hypotension. Neurology [Internet]. 2004 Nov 23;63(10):1950-1. doi.org/10.1212/01.WNL.0000144339.34733.E9. 3. Ferrante E, Arpino I, Citterio A, Wetzl R, Savino A. Epidural blood patch in Trendelenburg position pre‑medicated with acetazolamide to treat spontaneous intracranial hypotension. Eur J Neurol. 2010 May;17(5):715-9. doi: 10.1111/j.1468-1331.2009.02913.x. 4. Sarrafzadeh AS, Hopf SA, Gautschi OP, Narata AP, Schaller K. Intracranial hypotension after trauma. Springerplus. 2014;3(1):1-7. doi: 10.1186/2193-1801-3-153. 5. Chi NF, Wang SJ, Lirng JF, Fuh JL. Transtentorial herniation with cerebral infarction and duret haemorrhage in a patient with spontaneous intracranial hypotension. Cephalalgia. 2007 Mar;27(3):279-82. doi: 10.1111/j.1468-2982.2007.01259.x. 6. Zhang D, Wang J, Zhang Q, He F, Hu X. Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension: A Report on 4 Cases and a Review of the Literature. Headache. 2018 Sep;58(8):1244-1255. doi.org/10.1111/head.13413. 7. Pleasure SJ, Abosch A, Friedman J, Ko NU, Barbaro N, Dillon W, Fishman RA, Poncelet AN. Spontaneous intracranial hypotension resulting in stupor caused by diencephalic compression. Neurology. 1998 Jun;50(6):1854-7. doi: 10.1212/wnl.50. 6. 1854. 8. Chan SM, Chodakiewitz YG, Maya MM, Schievink WI, Moser FG. Intracranial Hypotension and Cerebrospinal Fluid Leak. Neuroimaging Clin N Am. 2019 May 1;29(2):213-26. doi: 10.1016/j.nic.2019. 01. 002. 9. Chazen JL, Talbott JF, Lantos JE, Dillon WP. MR myelography for identification of spinal CSF leak in spontaneous intracranial hypotension. American Journal of Neuroradiology. 2014 Oct 1;35(10):2007-12. doi: 10.3174/ajnr.A3975.
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