Intracranial hypotension secondary to spinal arachnoid cyst rupture presenting with acute severe headache: a case report

<p>Abstract</p> <p>Introduction</p> <p>Headache is a common presenting complaint and has a wide differential diagnosis. Clinicians need to be alert to clues that may suggest an underlying secondary aetiology. We describe a novel case of headache secondary to intracranial hypotension which was precipitated by the rupture of a spinal arachnoid cyst.</p> <p>Case report</p> <p>A 51-year-old Indian female presented with sudden onset severe headache suggestive of a subarachnoid haemorrage. Investigations including a computed tomography brain scan, cerebrospinal fluid examination and a magnetic resonance angiogram were normal. The headache persisted and magnetic resonance imaging revealed bilateral thin subdural collections, a spinal subarachnoid cyst and a right-sided pleural effusion. This was consistent with a diagnosis of headache secondary to intracranial hypotension resulting from spinal arachnoid cyst rupture.</p> <p>Conclusions</p> <p>Spinal arachnoid cyst rupture is a rare cause of spontaneous intracranial hypotension. Spontaneous intracranial hypotension is a common yet under-diagnosed heterogeneous condition. It should feature significantly in the differential diagnosis of patients with new-onset daily persistent headache.</p

Acute Mesenteric Ischaemia on Unenhanced Computer-Tomography

We present a 39-year old man with mesenteric ischaemia. The initial unenhanced images of the, non-oral contrast CT abdomen clearly demonstrated increased density in a significant length of the small bowel and in the veins of the adjacent mesentery. Mesenteric ischaemia is a difficult diagnosis both clinically and radiologically and we demonstrate the potential benefits of an unenhanced abdominal scan (often left out if a contrast enhanced scan is to be performed) and the omission of oral bowel contrast in emergency scans

Pseudotumoural gastric lesion caused by fish bone perforation

We report the case of a 34-year-old previously fit and healthy male who presented to the accident & emergency department with non-specific abdominal pain. The patient proceeded to undergo laparotomy at which a large mass was found adjacent to the stomach. The impression at surgery was of a lymphoma or gastric carcinoma though CT had reported the likelihood of a fish bone or foreign body causing duodenal perforation. Histology later confirmed the presence of a fish bone surrounded by reactive tissue

Postpartum pneumoperitoneum and peritonitis after water birth

Pneumoperitoneum (the presence of free gas in the peritoneal cavity) usually indicates gastrointestinal perforation with associated peritoneal contamination. We describe the unusual case of a 28-year-old female, who was 7 days postpartum and presented with features of peritonitis that were initially missed despite supporting radiological evidence. The causes of pneumoperitoneum are discussed. In the postpartum period the female genital tract provides an alternative route by which gas can enter the abdominal cavity and cause pneumoperitoneum. In the postpartum period it is important to remember that the clinical signs of peritonism, guarding and rebound tenderness may be diminished or subtle due to abdominal wall laxity