Brain sagging after craniotomy and clipping of a ruptured aneurysm is a rare complication. Clinical and electrographic changes in patients with a final diagnosis of intracranial hypotension are not well described, and can be mistaken on rare occasions for other entities such as nonconvulsive status epilepticus. There may be resulting delay in the diagnosis and treatment of this potentially life-threatening disorder.
Case report and imaging.
We present a case of intracranial hypotension in which concerning continuous electroencephalogram (cEEG) and quantitative EEG (qEEG) findings were noted during active sagging of the brain, which resolved with supine positioning. During upright seating, cEEG showed high-amplitude bilateral rhythmic 2-Hz slow-wave activity, and bilateral increase of spectral delta power on qEEG, in association with neurologic decline in function. When placed in supine position, the cEEG and qEEG abnormalities resolved in conjunction with the recovery of neurologic function.
Brain sagging can be diagnosed using simple maneuvers such as supine positioning. This case report describes changes seen in cEEG and qEEG monitoring that accompany these maneuvers, which may provide further evidence for the diagnosis of brain sagging. Thus, cEEG and qEEG monitoring may have a role in the early detection and treatment of brain sagging.
*Department of Medicine, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, New York, U.S.A.;
†Department of Neurosurgery, Hofstra Northwell School of Medicine, Lenox Hill Hospital, New York, New York, U.S.A.;
Department of ‡Neurology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, New York, U.S.A.; and
§Department of Neurology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, New York, U.S.A.
Address correspondence and reprint requests to Sean T. Hwang, MD, 611 Northern Boulevard, Great Neck, NY 11021, U.S.A.; e-mail: firstname.lastname@example.org.
The authors have no funding or conflicts of interest to disclose.
Previously presented at the American Epilepsy Society Meeting, Houston, Texas, March 12, 2016.