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Case report
Deep venous structures distortion in spontaneous intracranial hypotension as an explanation for altered level of consciousness
  1. Abdulrazag M Ajlan1,2,
  2. Hosam Al-Jehani3,
  3. Carlos Torres4,
  4. Judith Marcoux3
  1. 1Department of Neurosurgery, Stanford, Palo Alto, California, USA
  2. 2Department of Neurosurgery, King Saud University, Saudi Arabia
  3. 3McGill University, Montreal, Quebec, Canada
  4. 4Department of Diagnostic Imaging, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr A M Ajlan, Department of Neurosurgery, Stanford, 1078 Tanland Dr, Unit 103, Palo Alto, CA 94303, USA; aajlan{at}stanford.edu

Abstract

Spontaneous intracranial hypotension (SIH) is a syndrome of low pressure headache associated with low CSF pressure. The condition is generally considered benign but extreme cases of SIH can lead to changes in the level of consciousness. We describe a case in which alteration in the level of consciousness was prolonged and severe, and could not be explained solely by the presence of subdural collections. MRI of the brain showed evidence of impaired venous flow secondary to brain sagging causing distortion of deep venous structures.

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