PMID- 23971956
OWN - NLM
STAT- MEDLINE
DCOM- 20140512
LR  - 20140303
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 120
IP  - 3
DP  - 2014 Mar
TI  - Intracranial hypotension masquerading as nonconvulsive status epilepticus: report 
      of 3 cases.
PG  - 624-7
LID - 10.3171/2013.7.JNS112308 [doi]
AB  - Intracranial hypotension (IH) has been a known entity in neurocritical care since 
      1938. Even though many cases are spontaneous, the incidence of intracranial 
      hypotension in the neurocritical care setting is increasing by virtue of the 
      increased number of neurosurgical interventions. Whether spontaneous or secondary 
      in etiology, diagnosis of IH usually requires the presence of orthostatic 
      symptoms, including headaches and nausea with low opening CSF pressure. However, 
      typical clinical features in the appropriate clinical context and imaging, even 
      with normal CSF pressure, can indicate IH. In the neurocritical care setting, 
      challenges for accurate semiology include altered sensorium and reduced levels of 
      responsiveness for which many etiologies may exist, including metabolic 
      dysfunction, traumatic brain injury, IH, or nonconvulsive status epilepticus 
      (NCSE). The authors describe 3 patients whose clinical picture and 
      electroencephalography (EEG) findings initially suggested NCSE but who did not 
      respond to treatment with antiepileptic drugs alone. Neuroimaging suggested IH, 
      and subsequent treatment of IH successfully improved the patient's clinical 
      status. To the authors' knowledge this paper is the first in the literature that 
      reports a correlation of IH with electrographic findings similar to NCSE as cause 
      and effect. The authors' hypothesis is that thalamocortical dysfunction causes 
      EEG findings that appear to be similar to those in NCSE but that these conditions 
      do not coexist. The EEG activity is not epileptogenic, and IH results in blocking 
      network pathways producing thalamocortical dysfunction. The authors discuss the 
      hypothesis and pathophysiology of these epileptiform changes in relation to IH.
FAU - Hedna, Vishnumurthy Shushrutha
AU  - Hedna VS
AD  - Departments of Neurology and.
FAU - Kumar, Abhay
AU  - Kumar A
FAU - Miller, Bayard
AU  - Miller B
FAU - Bidari, Sharathchandra
AU  - Bidari S
FAU - Salardini, Arash
AU  - Salardini A
FAU - Waters, Michael F
AU  - Waters MF
FAU - Hella, Maria
AU  - Hella M
FAU - Valenstein, Edward
AU  - Valenstein E
FAU - Eisenschenk, Stephan
AU  - Eisenschenk S
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20130823
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
RN  - 0 (Anticonvulsants)
SB  - IM
MH  - Aged
MH  - Anticonvulsants/therapeutic use
MH  - Diagnosis, Differential
MH  - Electroencephalography
MH  - Female
MH  - Humans
MH  - Intracranial Hypotension/*diagnosis
MH  - Magnetic Resonance Imaging
MH  - Middle Aged
MH  - Status Epilepticus/*diagnosis/drug therapy
EDAT- 2013/08/27 06:00
MHDA- 2014/05/13 06:00
CRDT- 2013/08/27 06:00
PHST- 2013/08/27 06:00 [entrez]
PHST- 2013/08/27 06:00 [pubmed]
PHST- 2014/05/13 06:00 [medline]
AID - 10.3171/2013.7.JNS112308 [doi]
PST - ppublish
SO  - J Neurosurg. 2014 Mar;120(3):624-7. doi: 10.3171/2013.7.JNS112308. Epub 2013 Aug 
      23.