Department of Neurological Surgery, University of Washington, Seattle, USA; Neurosurgery, Mater Dei Hospital, Belo Horizonte, Brazil.
Neurosurgery, Mater Dei Hospital, Belo Horizonte, Brazil.
World Neurosurg. 2020 Nov;143:56-61. doi: 10.1016/j.wneu.2020.07.134. Epub 2020 Jul 23.
Low-pressure hydrocephalus (LPH) is a relatively rare condition, and its presentation is similar to the classically seen high-pressure hydrocephalus, with headaches, cranial nerve dysfunction, ataxia, and disturbances of consciousness. Cerebral cerebrospinal fluid loss in the presence of altered brain viscoelastic properties has previously been suggested as the pathophysiologic process leading to ventriculomegaly, despite low or negative intracranial pressures and patent shunts. More recently, cerebral venous overdrainage has been proposed as a possible explanation in the pathogenesis of LPH, although its connection to lumbar punctures in patients with shunts has not been contemplated yet. The effectiveness of epidural blood patch in the management of post-lumbar puncture LPH has been shown in children but has not been reported in adults.
Herein we detail 2 episodes of shunt malfunction in a 30-year-old female patient with a history of hydrocephalus related to a posterior fossa tumor diagnosed during childhood. In both instances, imaging studies demonstrated ventricular dilation along with perimedullary cistern enlargement and brainstem distortion, which occurred following a lumbar puncture despite a patent shunt. A lumbar blood patch was effective in both episodes, enabling resolution of the ventriculomegaly and a good outcome.
A blood patch can be efficient in adults with post-lumbar puncture LPH. Some symptoms may be explained by brainstem compression caused by enlarged cerebrospinal fluid spaces at the skull base. The role of cerebral venous overdrainage in the setting of post-lumbar puncture LPH is further supported.
低颅压性脑积水（LPH）是一种相对罕见的病症，其表现与经典的高颅压性脑积水相似，有头痛、颅神经功能障碍、共济失调和意识障碍。先前认为，在脑粘弹性改变的情况下，脑脊液丢失是导致脑室扩大的病理生理过程，尽管颅内压较低或为负，分流管通畅。最近，有人提出脑静脉过度引流可能是 LPH 发病机制的一个解释，尽管尚未考虑到分流管患者腰椎穿刺与它的联系。硬膜外血贴在治疗腰椎穿刺后 LPH 中的有效性已在儿童中得到证实，但尚未在成人中报道。
本文详细介绍了一位 30 岁女性患者的 2 次分流器故障，该患者儿童时期被诊断为后颅窝肿瘤相关脑积水。在这两种情况下，影像学研究均显示脑室扩张，伴围髓质池扩大和脑干变形，尽管分流管通畅，但在腰椎穿刺后出现这些情况。在这两种情况下，腰椎血贴均有效，使脑室扩大得到缓解，预后良好。
腰椎穿刺后 LPH 的成人患者，血贴可能有效。一些症状可能是由于颅底脑脊液空间扩大导致脑干受压引起的。进一步支持了腰椎穿刺后 LPH 中脑静脉过度引流的作用。
