Cervical bone spur presenting with spontaneous intracranial hypotension

Case report

A. Giancarlo VishtehDivision of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, Arizona

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Wouter I. SchievinkDivision of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, Arizona

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Jonathan J. BaskinDivision of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, Arizona

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Volker K. H. SonntagDivision of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, Arizona

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✓ Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The exact cause of these CSF leaks often remains unknown. The authors treated a 32-year-old man with a unique cause of spontaneous intracranial hypotension. He suffered an excruciating headache that was exacerbated by his being in an upright position. The results of four-vessel cerebral angiography were negative; however, magnetic resonance (MR) imaging of the brain revealed pachymeningeal enhancement and hindbrain herniation. A presumptive diagnosis of spontaneous intracranial hypotension was made. Myelography revealed extrathecal contrast material ventral to the cervical spinal cord as well as an unusual midline bone spur at C5–6. The patient's symptoms did not resolve with the application of epidural blood patches, and he subsequently underwent an anterior approach to the C5–6 spur. After discectomy, a slender bone spur that had pierced the thecal sac was found. After its removal, the dural rent was closed using two interrupted prolene sutures. The patient was discharged home 2 days later. On follow up his symptoms had resolved, and on MR imaging the pachymeningeal enhancement had resolved and the cerebellar herniation had improved slightly.

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  • 1.

    Benzon HT, , Nemickas R, & Molloy RE, et al: Lumbar and thoracic epidural blood injections to treat spontaneous intracranial hypotension. Anesthesiology 85:920922, 1996 Benzon HT, Nemickas R, Molloy RE, et al: Lumbar and thoracic epidural blood injections to treat spontaneous intracranial hypotension. Anesthesiology 85:920–922, 1996

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  • 2.

    Rando TA, & Fishman RA: Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 42:481487, 1992 Rando TA, Fishman RA: Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 42:481–487, 1992

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  • 3.

    Renowden SA, , Gregory R, & Hyman N, et al: Spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 59:511515, 1995 Renowden SA, Gregory R, Hyman N, et al: Spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 59:511–515, 1995

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  • 4.

    Schievink WI, , Ebersold MJ, & Atkinson JLD: Roller-coaster headache due to spinal cerebrospinal fluid leak. Lancet 347:1409, 1996 (Letter) Schievink WI, Ebersold MJ, Atkinson JLD: Roller-coaster headache due to spinal cerebrospinal fluid leak. Lancet 347:1409, 1996 (Letter)

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  • 5.

    Schievink WI, , Meyer FB, & Atkinson JLD, et al: Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84:598605, 1996 Schievink WI, Meyer FB, Atkinson JLD, et al: Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84:598–605, 1996

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  • 6.

    Schievink WI, , Morreale VM, & Atkinson JLD, et al: Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg 88:243246, 1998 Schievink WI, Morreale VM, Atkinson JLD, et al: Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg 88:243–246, 1998

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  • 7.

    Schievink WI, , Reimer R, & Folger WN: Surgical treatment of spontaneous intracranial hypotension associated with a spinal arachnoid diverticulum. Case report. J Neurosurg 80:736739, 1994 Schievink WI, Reimer R, Folger WN: Surgical treatment of spontaneous intracranial hypotension associated with a spinal arachnoid diverticulum. Case report. J Neurosurg 80:736–739, 1994

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  • 8.

    Weitz SR, & Drasner K: Spontaneous intracranial hypotension: a series. Anesthesiology 85:923925, 1996 Weitz SR, Drasner K: Spontaneous intracranial hypotension: a series. Anesthesiology 85:923–925, 1996

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