Síndrome de hipotensión intracraneal en paciente neurocrítico: reporte de caso

Abstract

Objective

to highlight the importance of recognizing intracranial hypotension syndrome (ICH), derived from the use of a spinal drainage (SD), in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Clinical Case

a 42-year-old female patient with no prior medical history was admitted to the emergency department due to a generalized tonic-clonic seizure. An initial diagnosis of aSAH was made using brain CT angiography, and an aneurysm was treated through endovascular therapy with coils. SD was placed for management, but the patient subsequently developed SIH, characterized by negative intracranial pressure (ICP) and orthostatic headache as her cardinal symptoms.

Discussion

SIH presents with both clinical and radiological features, with orthostatic headache and cerebellar tonsillar descent being among the most common findings. Various treatment options for SIH have been described in the literature. However, the epidural blood patch is one of the most effective alternatives when performed using the appropriate technique.

Conclusions

SD is an effective alternative with a low rate of side effects in the management of aSAH. However, it is crucial to be aware of the associated risks. Proper knowledge of the different clinical presentations and diagnostic approaches is essential for managing SIH.