Management of cervical CSF-venous fistula causing acute cognitive impairment and coma
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Authors
Carlton Jones, Lalani
Hoffmann, Jan
Mohideen, Saamir
Stanton, Biba
Bleil, Cristina
Britton, Tom
Goadsby, Peter J.
Zebian, Bassel
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Issue Date
2024
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Article
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Abstract
CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.
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Acta Neurochirurgica
Volume
166
Issue
1