586
KAZUISTIKA425200011157120176236269319376408468532
/982200011133
CASE1040200011155117168223
REPORT1288200011157113168230289344
Intracranial425320097196491117157193220260304324363382
hypotension8243200974481128174201241286318337382427
in12683200971863
a134832009739
young14043200973781126171217
male163832009767106125166
patient18213200974685112131172217244
associated20823200973870102147184203242269309355
with24543200975979106151
shoulder26223200973176121166185231272299
injury2938320097196483128154195
24615620001114293142
|342200011126
ANESTEZIOLOGIE4268040010753112155200245290342362425467527586607650
A10988040010753
INTENZIVNÍ1172804001071978123168227276296345405426
MEDICÍNA16198040010770114174195248268328382
/20468040010732
Anest21238040010753101145179208
intenziv235180400107186693136184221240281
Med.26528040010770114164180
2024;35(4):245-2472852804001074487128168183227268290332353368412452493521560600640
/35378040010732
www.aimjournal.cz48358040010765133201214257275349367415463490539579598614654693
in425314001071966
consciousness,513314001074085133165205223270317349396439472505520
which10543140010765113131170217
was12933140010765106138
consistent1453314001074086133165183215243284332357
with1832314001076584111158
the2012314001072875118
changes2152314001074087127174223266299
in2472314001071966
ICP2560314001071970113
levels.2695314001071962102144163194210
Higher425328001075774123170213239
ICP682328001071969113
levels813328001071962102144162194
were10253280010765108133175
associated1218328001074173106153194211251277319368
with1604328001076583110157
a17793280010741
better1838328001075094121150192218
state2074328001073361102128169
of2261328001074871
consciousness.2350328001074086134166206223271318350397440473505521
Due5653420010760111159
to762342001072980
the879342001072982130
observed10473420010749104141189220268315370
correlation1454342001074293123154201224269300322374427
between19193420010751100132204252301354
improved2310342001072098152183234279326380
consciousness272834200107419214542535600107347798149199235285332368404
and859356001074192144
elevated1034356001074465112155199228274326
ICP,1391356001071973120127
concerns1548356001074190141184229258310345
arose1924356001074170119155202
regarding2156356001072773126169197248269320372
CSF2558356001075297140
leakage.2729356001071965108149425370001074193140157
However,6123700010757108176221264310339353
a9953700010741
magnetic10673700010774117169220266296317360
resonance1457370001072773109159210254304347392
(MRI)1879370001072495143165190
scan2100370001073477121171
was23023700010765109145
performed,2477370001075098126155205235312358411428
revealing425384001072671113157199219239288339
an784384001074090
unexpected894384001074797142183234281323355399450
C51364384001075198
and1481384001074190141
C61642384001075195
root1757384001072675125154
avulsion1930384001074182132152186206256305
without2255384001076586115165214264294
any2568384001074190130
signs2718384001073353104153187
of425398001074874
vertebrae526398001074186114147191243271315361
trauma.914398001072857100149225267285
Because1227398001074592135178227262308
of1563398001074773
this166439800107287898132
finding,182439800107244595146167216267285
CT2136398001075299
perimyelography2262398001075097125146221261307328378430458501552603643
was4254120010765108143
performed592412001075097125154203232308354406
revealing1022412001072772114159201222242292343
CSF1389412001075196138
leakage1551412001071965107147191242288
through1863412001072878106155205256306
the2193412001072878124
C52341412001075298
and2464412001074090142
C62630412001075196
root2750412001072675126155
avulsion425426001074182133153188208258308
as756426001074176
depicted856426001074995146167209241285337
in1217426001071868
Fig.1308426001074262113131
2.1459426001074359
After565664001075376108152180
the774664001072878124
finding,92766400107244595146167216267285
the1241664001072878124
patient1394664001074993122142188238266
was16896640010765109144
positioned18626640010749100136156186206256306352404
in2295664001071969
the2393664001072878124
dorsal2546664001074899127163207228
recumbent2803664001072671425678001074088162212258306334
position.778678001074999133153182202250299317
The1114678001074192136
ICP1270678001071870116
stabilized1405678001073363105155175195215252296346
spontaneously1771678001073382132182209251300345395443477497538
at2328678001074068
around2416678001074067115164212262
326986780010743
mm27596780010773146
Hg4256920010757108
on562692001074898
the690692001072777123
4th842692001074473123
day994692001074992132
following115569200107247395115165232253303354
admission.1538692001074192167188222257277327378396
The1963692001074193139
patient2131692001075093122143188238267
regained2427692001072671123166186236282334
full279069200107237495115
consciousness425706001074089139174216237286336371421467502537
and989706001074191142
was11577060010765109144
extubated1327706001074485118168219262291336387
on1741706001074898
the1866706001072878124
5th2016706001074471121
day2164706001074991132
and2322706001074191142
discharged2491706001074969104146196239267317363414
from425720001072453102179
the634720001072778124
ICU788720001071973130
on948720001074899
the1077720001072878124
6th1231720001074474124
day.1385720001074992133146
After1561720001075379112157185
discharge1776720001074970104147197240268318364
from2170720001072453102179
the2379720001072878124
ICU,2533720001071973130145
there2708720001072879125153198
were4257340010765110139183
no637734001074898
signs764734001073353104154189
of981734001074874
continuous1084734001074088139167188238287337387422
CSF1534734001075296138
leakage,1701734001071965107146191242288304
including2033734001071969111132181232253302354
follow‑up241573400107247395115165231261312364
CT2807734001075198
perimyeolography.425748001075096125146221261306357379429481509552603654694708
A11587480010753
follow‑up123674800107247395115165232262312364
MRI16257480010770118139
scan1789748001073476119169
was19847480010765108143
performed2152748001075097125154203232308354406
showing2583748001073483134200221271322
signs425762001073455107158194
of650762001074875
pseudomeningocele756762001075087134185237288366413464485536588640684729751798
formation1585762001072474104182225255276327379
(see1995762001072459106154
Fig.2180762001074263115133
3).234476200107456984
The2459762001074395142
patient2632762001075195125146193244274
remained425776001072771147189210259305357
in809776001071969
hospital905776001074898134185206235279299
till12317760010728496990
the1348776001072777123
24th1498776001074486115165
day.1690776001074992132146
From1863776001074166113187
the2074776001072776120
discharge2217776001074968101141189230256304348
from258977600107235198172
the2785776001072876120
ICU304762001071971126
till3193620010727466583
the329662001072876120
discharge343562001074968101141189230256305349
from38036200107245198173
hospital,399562001074897130179198227268287302
the431662001072876120
management4456620010774114162203252296370414463489
was4965620010765106139
focused512462001072371112160193237287
on543062001074897
rehabilitation304776001072770118159208227246264292334361380428476
and354376001074189138
analgesia.370176001074189130149198242276294334351
The3187356001074189132
patient3334356001074989115133175222247
underwent3596356001074794141184209275317364390
brachial4001356001074874114154200218257274
plexus4291356001074867109148194226
reconstruction4532356001072668107152199231259285332371400418464511
three505835600107287499141184
months52573560010772119166192239271
later.304737000107196087129155168
During32313700010759107133153200250
the3497370001072876120
surgery,3634370001073481107155199225268280
C5,3931370001075196110
C6,4057370001075294110
and4183370001074189138
C74338370001075195
roots4450370001072774122150184
were46513700010765108135178
reconstructed4845370001072770111157206239268295343383414456506
with5368370001076584112160
the3047384001072876121
use3194384001074881126
of3346384001074872
grafts3445384001074975117141172207
from367938400107235198173
the3878384001072877121
posterior40253840010750100133162205232251299326
division4378384001074968109129161180228277
of4681384001074872
the4780384001072876121
upper4927384001074898148193220
trunk5173384001072855103152190
and5389384001074189139
suprascapular3047398001073481130157199232273314364412431471498
nerve.3568398001074993119163206221
Presently,3813398001074571114147192240267286326337
the4174398001072876120
patient4318398001074991118137181229256
shows4597398001073482130195229
paresis4849398001075092118161195213245
of5118398001074872
the5214398001072776120
right535739800107274695143170
arm3047412001074167142
classified3208412001074059100133166185209228272322
as3550412001074174
score3644412001073374121148191
238544120010744
on3918412001074896
the4034412001072876120
Neurological41744120010758102150176223243291341360400441460
Impairment4654412001071992142184202228303347395422
Scale5096412001074282124143187
(NIS).5302412001072481100141164177
Discussion30474360015382123178237310363418459524597
Intracranial304745400107196489113153191215254300316354371
hypotension3430454001074884132179204244290321337382428
is3871454001071949
a39324540010741
rare398545400107276690131
condition4128454001074084130177194219236281328
that4468454001072873112137
is4617454001071949
typically4679454001072767115132170209226242280
characterized4972454001073985123147187225253293317334368409456
by5441454001074986
postural3047468001075097129156202227267284
headaches,3347468001074891129177215254300343375389
rarely375246800107276791132150188
by3956468001075088
coma.4060468001074085157196211
Severe4287468001074284123164189230
cases4533468001074180112154186
can4735468001074080126
be4878468001074993
life‑threatening.49874680010719355899127153199224265303329369416432479526540
Major30474820010770109126173198
severe3258482001073376115156181222
complications3493482001074085157205223239278317343360406453484
are3990482001074165107
cerebellar4110482001074080105146194237255271310335
haemorrhage,4458482001074887129201248273298345384431474486
posterior4958482001074997128155196221238284310
circulation528148200107405781118164181220304749600107274489134
infarction,319349600107196384123147183211227272318331
brain3536496001074873111127172
herniation,3720496001074889113159174212236253298343356
and4088496001074085132
cerebral4231496001074079103143190214253269
venous4512496001074080125171216246
sinus477049600107334994138168
thrombosis495049600107277396140211257304334350380
[5–7].534249600109256711015017455124960010715
Normally,30475100010757104129202241258275313323
intracranial339151000107196590115155194218258304321360377
hypotension3789510001074985134181207248294325342388435
causes4245510001074080126157199231
recurring4498510001072667107153177203220266314
postural4833510001075097129156202227267284
headaches,5139510001074890128176215254300342374388
but3047524001075096123
coma3184524001074085158196
can3395524001074080126
rarely353652400107266691132149188
be3738524001075093
the3846524001072874116
sole397752400107348098140
sign,413252400107335097143157
as4304524001074172
it4391524001071945
was44515240010765104136
in4601524001071965
the4681524001072874117
presented4812524001075075116148190237262303351
case5178524001074079111153
[1–2].534652400109266710714817055125240010716
IH3047538001071974
is3135538001071950
rarely320053800107266690132149187
associated3402538001074172104150190207245270311359
with3776538001076582109155
trauma.394653800107275292138210249263
More42245380010770116142183
often,4421538001074870100141187201
it4636538001071946
occurs4696538001074887124170195227
in4938538001071965
neurointensive5017538001074991137161207224270295336382413430469510
care3047552001074080104146
units,3211552001074794110137170184
mostly34135520010773120152179196235
in3666552001071865
association3749552001074072103150189206245270287333380
with4147552001076583109155
neurosurgery4320552001074891137161207238284308354397421463
or4801552001074873
ventricular/lumbar4892552001074082128153178196234280297336360387406451523571611635
drainage.3047566001075075115133179219267310324
In3394566001071966
well‑documented34845660010766108126143170220267307354427470517543584634
cases4141566001074081113156189
by4353566001075089
Sarrafzadeh,4465566001074283108134174197235276324367414429
IH4917566001071975
was50155660010766106138
a51775660010741
result5241566001072769102148165192
of5456566001074971
a30475800010741
spine310958000107348199145187
injury331858000107186481127151193
with3532580001076582109155
a37095800010740
CSF3771580001075192131
leak3923580001071961100136
[4].40815800010926689041675800010716
Interestingly,420458000107196590131156197229256273319367384422432
in4657580001071965
our4743580001074895119
case,4884580001074079111153166
there5072580001072774116141182
was52755800010765105136
no5433580001074895
spine304759400107348199145188
injury.325859400107196582128152194204
We34855940010774114
only3622594001074895113151
diagnosed3796594001074966105153199246278321369
avulsions4188594001074179126144175191238285316
of4527594001074870
two4620594001072894140
roots4783594001072772120146179
resulting4985594001072668100145162189206252300
in5308594001071965
CSF5396594001075293132
leakage.3047608001071961100136176224266279
Notably,33426080010758104130169217235273283
there3641608001072874117142183
was38406080010765104136
no3992608001074895
injury410360800107196582127152193
to4312608001072873
surrounding4401608001073379103129174220267314331377425
vessels.4842608001074082114145188205236251
In3187622001071967
most32806220010774123156185
trauma349262200107275496143217258
patients,3776622001075092119138181230257291307
the4110622001072876120
whole‑body42566220010765114163182226256306356406446
CT4728622001075297
scan4851622001073475116164
is5041622001071952
performed.5119622001075095121148196223297342392408
Nonetheless,30476360010758107156200228277321341385419452469
the3542636001072877121
CT3690636001075197
scan3813636001073475117165
is4005636001071851
not4083636001074897125
sufficiently4234636001073481106133153194212257305332351392
sensitive4652636001073478127160179207226267311
to4989636001072875
diagnose5091636001074968108158206255289334
IH5451636001071976
or3047650001074876
CSF3150650001075295136
leakage.3313650001072064105144187237282297
CT3637650001075298
may37616500010775116156
show3944650001073482132197
CSF4168650001075296137
collections,4332650001074088108127171213244263312362395412
which47716500010765115134175224
can5021650001074183132
make51806500010774116155198
the5405650001072877122
diagnosis3047664001075069110160209258292310344
easier3418664001074485118137182209
[8].36546640010926719637486640010716
This3791664001074292111145
was39636640010765107141
demonstrated4131664001075094169218268301331358400428471522
by4680664001075090
Sarrafzadeh4797664001074285111139181205245288338383432
in5256664001071968
both53516640010750100127177
documented3047678001074997137185258302350376418468
cases3531678001074081114158191
where37396780010764113156183225
CSF3980678001075294134
collection4130678001074086106124168209239257305353
was44996780010765106139
a46546780010741
key4711678001073881120
finding.484867800107234390139157205254270
In5134678001071967
our5217678001074795121
case,5355678001074081114157172
however,3047692001074998163207249292319331
the3405692001072877122
CSF3554692001075295136
leak3717692001071964104143
did3887692001074968118
not4032692001074897125
form418469200107247299175
a43856920010742
collection.4453692001074188108127172213244263312361378
To4858692001074285
prompt4970692001075078125200250278
further5275692001072474100132181226252
imaging3047706001071992133182201249298
studies,3367706001073362110160178222256272
there3660706001072877121147190
should3872706001073381130178197246
be4139706001075095
a42567060010740
firm431870600107244370144
clinical448470600107405977125144184225244
suspicion4750706001073380113163182222241289337
of5109706001074872
IH.520270600107197692
In5316706001071967
our5404706001074897123
case,3047720001074183117162177
the3251720001072877122
suspicion3400720001073482116166186227246295344
was37717200010766108142
based3940720001075193127172223
on4190720001074998
a43157200010742
very4384720001074185112156
low4567720001071968134
and4728720001074291141
negative4896720001074994145186214233275319
ICP5242720001072072118
and5387720001074190140
an3047734001074189
improvement3158734001071993142169216256300373417466492
in3673734001071967
the3762734001072876120
state3905734001073362104131173
of4101734001074872
consciousness4195734001074187136169209228276324357405449483516
with4734734001076584112160
higher4917734001074866116164208234
ICP5174734001071970115
levels.5311734001071963104147167199216
Another30477480010753101149177225269295
imaging3359748001071992133182201249298
method36747480010774118146194242292
to3983748001072874
consider4074748001074087135168187236280306
is4397748001071951
cranial4465748001074067108156175215234
MRI47167480010770115135
which48687480010764113132172220
can5105748001074081129
provide5251748001075076124164183232276
the3047762001072876120
diagnosis3191762001074967108157205254287305338
in3553762001071866
80%3643762001074488156
of3822762001074872
cases3918762001074081115159193
[8,413476200109267090
9].424676200109477043157620010716
We43547620010774116
performed4493762001075095122148196223297341392
an4908762001074189
MRI50217620010770115135
scan5179762001073475116164
with5367762001076584112160
the3047776001072876120
finding318877600107244391141159207256
of3465776001074872
avulsions3558776001074180129148180199247295328
without3907776001076584112161209257285
clear4213776001074059103143170
signs4403776001073452101149182
of4606776001074872
CSF4698776001075295135
leakage.4854776001071963103141183233277291
Therefore,5166776001074292136162205229277304347361
Fig.42560001255687137164
1.60560001255478
CT72862001074891
brain83562001074571114132178
scan102962001073168112159
obtained120462001074590116159178224262307
after15286200107456897133159
admission170362001074591162180209240257302348
to206862001072670
ICU215462001071967119
Fig.428443001255688138165
2.614443001255581
CT740444001074991
perimyelography.853444001074584110128200236273292337384409452498545580594
The1469444001074087126
arrow161644400107467298142204
indicates1842444001071965111129167211237274305
C52169444001074890
root2281444001072670117143
avulsion2445444001074684130149178195241288
with2755444001076280106152
leakage428455001071957102139183228267
of712455001074568
contrast798455001073781127152178221251277
fluid109245500107234489108153
showing1262455001073277122184202248293
probable1573455001074571115161206252270309
location1899455001071964102146172190235282
of2198455001074568
cerebrospinal2284455001073774100136182208251281326344390435454
fluid275545500107234489108153
leakage428466001071957102139183228267
Fig.sub304795001255687137164207264318
3.338195001255479
Follow-up350696001073983102120165228254301347
MRI.3869960010767111129146
The403196001073987125
arrow41729600107457196140203
indicates439096001071965110129166210236272304
the470996001072773111
formation48369600107236793164209235253299345
of519796001074568
a5281960010745
pseudomeningocele5342960010745751131593047107001074590162200247265311356401439476494532