Management of cervical CSF-venous fistula causing acute cognitive impairment and coma
Lalani Carlton Jonesa b c✉, Jan Hoffmannd e, Saamir Mohideend, Biba R. Stantond, Cristina Bleilf, Tom Brittond, Peter James Goadsbyd e, Bassel Zebianf
- aDepartment of Neuroradiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. lalani.carltonjones@nhs.net
- bDepartment of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH, UK. lalani.carltonjones@nhs.net
- cDepartment of Neuroradiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- dDepartment of Neurology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- eWolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- fDepartment of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- ✉Corresponding author
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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.