Management of cervical CSF-venous fistula causing acute cognitive impairment and coma

Lalani Carlton Jones; Jan Hoffmann; Saamir Mohideen; Biba Stanton; Cristina Bleil; Tom Britton; Peter J. Goadsby; Bassel Zebian

doi:10.1007/s00701-024-05935-0

Management of cervical CSF-venous fistula causing acute cognitive impairment and coma

Lalani Carlton Jones^*, Jan Hoffmann, Saamir Mohideen, Biba Stanton, Cristina Bleil, Tom Britton, Peter J. Goadsby, Bassel Zebian

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.

Original language	English
Article number	37
Journal	Acta Neurochirurgica
Volume	166
Issue number	1
Early online date	26 Jan 2024
DOIs	https://doi.org/10.1007/s00701-024-05935-0
Publication status	E-pub ahead of print - 26 Jan 2024

Keywords

CSF-venous fistula
Frontotemporal dementia
Spinal CSF leak
Spontaneous intracranial hypotension

Access to Document

10.1007/s00701-024-05935-0

Cite this

@article{e32cc6cbc2a64ce79567074330f179f6,

title = "Management of cervical CSF-venous fistula causing acute cognitive impairment and coma",

abstract = "CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.",

keywords = "CSF-venous fistula, Frontotemporal dementia, Spinal CSF leak, Spontaneous intracranial hypotension",

author = "{Carlton Jones}, Lalani and Jan Hoffmann and Saamir Mohideen and Biba Stanton and Cristina Bleil and Tom Britton and Goadsby, {Peter J.} and Bassel Zebian",

note = "Publisher Copyright: {\textcopyright} 2024, The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.",

year = "2024",

month = jan,

day = "26",

doi = "10.1007/s00701-024-05935-0",

language = "English",

volume = "166",

journal = "Acta Neurochirurgica",

issn = "0001-6268",

publisher = "Springer Wien",

number = "1",

}

TY - JOUR

T1 - Management of cervical CSF-venous fistula causing acute cognitive impairment and coma

AU - Carlton Jones, Lalani

AU - Hoffmann, Jan

AU - Mohideen, Saamir

AU - Stanton, Biba

AU - Bleil, Cristina

AU - Britton, Tom

AU - Goadsby, Peter J.

AU - Zebian, Bassel

PY - 2024/1/26

Y1 - 2024/1/26

N2 - CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.

AB - CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.

KW - CSF-venous fistula

KW - Frontotemporal dementia

KW - Spinal CSF leak

KW - Spontaneous intracranial hypotension

UR - http://www.scopus.com/inward/record.url?scp=85183029513&partnerID=8YFLogxK

U2 - 10.1007/s00701-024-05935-0

DO - 10.1007/s00701-024-05935-0

M3 - Article

C2 - 38277029

AN - SCOPUS:85183029513

SN - 0001-6268

VL - 166

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

IS - 1

M1 - 37

ER -

Management of cervical CSF-venous fistula causing acute cognitive impairment and coma

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this