Document Detail

Orthostatic headaches in the syndrome of the trephined: resolution following cranioplasty.
MedLine Citation:
PMID:  20561067     Owner:  NLM     Status:  In-Process    
OBJECTIVE: To draw attention to the syndrome of the trephined as a potential cause for orthostatic headaches without cerebrospinal fluid (CSF) leak.
BACKGROUND: Orthostatic headaches typically result from CSF leaks but sometimes may occur in conditions without any evidence of CSF leakage.
METHODS: A 37-year-old right-handed woman became comatose after a motor vehicle accident with cerebral contusions and massive left cerebral edema. A large frontoparietal craniectomy was carried out. In 5 months, she made good neurologic recovery. Freeze-preserved bone flap was placed back. In several weeks she was functionally near normal. Two years later, she began to complain of orthostatic headache and gradually additional manifestations appeared including progressive gait unsteadiness, imprecise speech, cognitive difficulties, and an increasing left hemiparesis along with progressive sinking of the skull defect and shift of the midline and ventricular distortion. She underwent removal of resorptive sinking bone flap and construction of an acrylic cranioplasty.
RESULTS: At 6-month follow-up, there was complete resolution of the orthostatic headaches, remarkable neurologic improvement along with resolution of midline shift and ventricular distortion.
CONCLUSION: The syndrome of the trephined is yet another cause of orthostatic headaches without CSF leak.
Bahram Mokri
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-06-18
Journal Detail:
Title:  Headache     Volume:  50     ISSN:  1526-4610     ISO Abbreviation:  Headache     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985091R     Medline TA:  Headache     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1206-11     Citation Subset:  IM    
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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