Abstract
Transient anoxic seizure upon application of pressure on a giant pseudomeningocele has never been reported in the literature; such abrupt changes in intracranial pressure due to large volume of cerebrospinal fluid (CSF) translocation, if left untreated may lead to permanent cerebral hypoxic injury and death. Here we describe a case of a 26-year-old woman who had undergone lumbar disc surgery in another unit few months ago and developed a large lump around her back. Any pressure on the lump resulted in headaches and at times episodes of seizures. Clinical examination revealed a very large fluid-filled lump consistent with a giant pseudomeningocele, confirmed by an MRI. A video EEG while applying pressure on the lump was recorded. The patient developed a typical seizure attack with a characteristic pattern of cerebral anoxia, and a paired ECG showed irregular rhythm with junctional and ventricular ectopic beats during the latter part of the attack, raising a suspicion of asystole. Upon relieving the pressure off the lump, the patient gradually regained consciousness with no permanent neurological deficit. We then discuss the pathophysiology of anoxic seizures and highlight the need to be vigilant in managing patients with such lesions in order to prevent permanent cerebral hypoxic injury and death.
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References
Alfery DD, Shapiro HM, Gagnon RL (1980) Cardiac arrest following rapid drainage of cerebrospinal fluid in a patient with hydrocephalus. Anesthesiology 52(5):443–444
Bekavac I, Halloran JI (2003) Meningocele-induced positional syncope and retinal hemorrhage. AJNR Am J Neuroradiol 24(5):838–839
Bergfeldt L (2003) Differential diagnosis of cardiogenic syncope and seizure disorders. Heart 89(3):353–358
Drummond JC, Ciacci JD, Lee RR (2014) Direct pressure on a pseudomeningocele resulting in intraoperative cerebral ischemia. Can J Anesth 61(7):656–659
Fehnel CR, Razmara A, Feske SK (2014) Coma from wall suction-induced CSF leak complicating spinal surgery. BMJ Case Rep 12:bcr2014203801
Foley JA, Rao RD (2009) Traumatic lumbosacral pseudomeningocele associated with spinal fracture. Spine J 9(11):e5–e10
Hamilton RG, Brown SW, Goetz LL, Miner M (2009) Lumbar pseudomeningocele causing hydronephrosis. J Spinal Cord Med 32(1):95–98
Kohler E, Prentice D (2010) Pseudomeningocele induced transient loss of consciousness in Marfan syndrome. Intern Med J 40(3):228–230
Liu C, Cai HX, Fan SW, Liu YJ (2010) Postoperative pseudomeningocele in a 40-year-old man. Ir J Med Sci 180(4):925–927
McNamara B, Ray J, Menon D, Boniface S (2003) Raised intracranial pressure and seizures in the neurological intensive care unit. Br J Anaesth 90(1):39–42
Miller PR, Elder FW (1968) Meningeal pseudocysts (meningocele spurius) following laminectomy. Report of ten cases. J Bone Joint Surg Am 50(2):268–276
Moon HS, Lee SK, Kim SR, Kim SJ (2016) Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report. Korean J Anesthesiology 69(3):293–295
Parpaley Y, Urbach H, Kovacs A, Klehr M, Kristof RA (2011) Pseudohypoxic brain swelling (postoperative intracranial hypotension-associated venous congestion) after spinal surgery: report of 2 cases. Neurosurgery 68(1):E277–E283
Srilomsak P (2012) Giant pseudomeningocele after spinal surgery: a case report. WJO 3(7):109–105
Stone JG, Bergmann LL, Takamori R, Donovan DJ (2015) Giant pseudomeningocele causing urinary obstruction in a patient with Marfan syndrome. J Neurosurg Spine 23(1):77–80
Toshniwal GR, Bhagat H, Rath GP (2007) Bradycardia following negative pressure suction of subgaleal drain during craniotomy closure. Acta Neurochir 149(10):1077–1079
Van Lieshout JJ, Wieling W, Karemaker JM, Secher NH (2003) Syncope, cerebral perfusion, and oxygenation. J Appl Physiol 94(3):833–848
Van Roost D, Thees C, Brenke C, Oppel F, Winkler PA, Schramm J (2003) Pseudohypoxic brain swelling: a newly defined complication after uneventful brain surgery, probably related to suction drainage. Neurosurgery 53(6):1315–1326
Weng Y-J, Cheng C-C, Li Y-Y, Huang T-J, Hsu RW-W (2010) Management of giant pseudomeningoceles after spinal surgery. BMC Musculoskelet Disord 11(1):53
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Hamdan, A., Saxena, A., Rao, G. et al. Compression of a giant pseudomeningocele causing transient anoxic seizures—a case report. Acta Neurochir 160, 479–485 (2018). https://doi.org/10.1007/s00701-017-3446-z
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DOI: https://doi.org/10.1007/s00701-017-3446-z