Tonsillar Herniation After Lumbar Puncture in Idiopathic Intracranial Hypertension

Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
Adeniyi A BorireChristian J Lueck

Abstract

A 30-year-old woman with coexisting renal tubular acidosis and idiopathic intracranial hypertension (IIH), treated with acetazolamide, experienced coning (cerebellar tonsillar herniation) after a lumbar puncture (LP). Brain magnetic resonance imaging at initial diagnosis of IIH showed minor tonsillar descent and computed tomographic venography revealed hypoplasia of the left transverse sinus. The patient previously had three uneventful LPs, all of which showed high opening pressures and normal cerebrospinal fluid composition. In retrospect, it was noted that her serum bicarbonate had fallen to 9 mmol/L (normal: 22-28 mm/L) 1 week before the LP. We hypothesize that the combination of cerebral edema (due to worsening metabolic acidosis), poor venous drainage, and preexisting minor tonsillar descent contributed to her post-LP coning.

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Citations

Feb 9, 2017·Journal of Neurosurgical Anesthesiology·Abhijit V LeleUNKNOWN Representing SNACC Task Force for Developing Guidelines for Perioperative Management of External Ventricular and Lumbar Drai
Mar 16, 2019·Practical Neurology·Peter GatesNeil Shuey
Jan 16, 2020·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Leman Tekin OrgunAyse Serdaroglu
Oct 15, 2019·Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society·Fiona CostelloRhea Varughese

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