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Antonescu-Ghelmez D, Butnariu I, Antonescu F, Maier C, Moraru A, Bucur AI, Anghel DN, Tuţă S. Thunderclap headache revealing dural tears with symptomatic intracranial hypotension: Report of two cases. Front Neurol 2023; 14:1132793. [PMID: 36908611 PMCID: PMC9996024 DOI: 10.3389/fneur.2023.1132793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Cerebrospinal fluid (CSF) leakage is considered the cause of spontaneous intracranial hypotension (SIH), an important etiology for new daily persistent headaches and a potentially life-threatening condition. Minor traumatic events rarely lead to CSF leakage, contrasting with iatrogenic interventions such as a lumbar puncture or spinal surgery, which are commonly complicated by dural tears. Most meningeal lesions are found in the cervicothoracic region, followed by the thoracic region, and rarely in the lumbar region, and extremely rarely in the sacral region. We describe two patients admitted to our hospital for severe headaches aggravated in the orthostatic position, with a recent history of minor trauma and sustained physical effort, respectively. In the first case, a bone fragment pierced an incidental congenital meningocele creating a dural fistula. An extensive extradural CSF collection, spanning the cervicothoracic region (C4-T10), was described in the second case. In both patients, the clinical evolution was favorable under conservative treatment.
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Affiliation(s)
- Dana Antonescu-Ghelmez
- Department of Neurology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioana Butnariu
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Florian Antonescu
- Department of Neurology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Maier
- MedInst Romanian-German Diagnostic Center, Bucharest, Romania
| | - Adriana Moraru
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Amanda Ioana Bucur
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniela Nicoleta Anghel
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Sorin Tuţă
- Department of Neurology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Neurology, National Institute of Neurology and Neurovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Singman E. From Provider to Advocate: The Complexities of Traumatic Brain Injury Prompt the Evolution of Provider Engagement. J Clin Med 2021; 10:jcm10122598. [PMID: 34204619 PMCID: PMC8231255 DOI: 10.3390/jcm10122598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022] Open
Abstract
Treating a patient with traumatic brain injury requires an interdisciplinary approach because of the pervasive, profound and protean manifestations of this condition. In this review, key aspects of the medical history and review of systems will be described in order to highlight how the role of any provider must evolve to become a better patient advocate. Although this review is written from the vantage point of a vision care provider, it is hoped that patients, caregivers and providers will recognize the need for a team approach.
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Affiliation(s)
- Eric Singman
- Wilmer Eye Institute, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
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