Management of an intracranial hypotension patient with diplopia as the primary symptom:A case report  

作　　者：Ting-Ting Wei Hua Huang Gang Chen Fei-Fang He 

机构地区：[1]Department of Anesthesiology,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310003,Zhejiang Province,China [2]Department of Pain Management,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310003,Zhejiang Province,China

出　　处：《World Journal of Clinical Cases》2021年第22期6544-6551,共8页世界临床病例杂志

摘　　要：BACKGROUND Intracranial hypotension(IH)is a disorder involving cerebrospinal fluid(CSF)hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed,especially in these patients without the prototypical manifestation of an orthostatic headache.At present,the management of IH with both cranial nerve VI palsy and bilateral subdural hematomas(SDHs)is still unclear.CASE SUMMARY A 67-year-old male Chinese patient complained of diplopia on the left side for one and a half mo.Computed tomography revealed bilateral SDHs and a midline shift.However,neurotrophic drugs were not effective,and 3 d after admission,he developed a non-orthostatic headache and neck stiffness.Enhanced magnetic resonance imaging revealed dural enhancement as an additional feature,and IH was suspected.Magnetic resonance myelography was then adopted and showed CSF leakage at multiple sites in the spine,confirming the diagnosis of having IH.The patient fully recovered following multiple targeted epidural blood patch(EBP)procedures.CONCLUSION IH is a rare disease,and to the best of our knowledge,IH with diplopia as its initial and primary symptom has never been reported.In this study,we also elucidated that it could be safe and effective to treat IH patients with associated cranial nerve VI palsy and bilateral SDHs using repeated EBP therapy.

关 键 词：Cranial nerve VI palsy Epidural blood patch Intracranial hypotension Subdural hematoma Case report 

分 类 号：R777.42[医药卫生—眼科] R544.2[医药卫生—临床医学]