Clinical Snapshot
Pseudohypoxic Brain Swelling—a Rare Complication of Neurosurgical Interventions
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A 57-year-old woman was slow to regain consciousness after uncomplicated lumbar interlaminar windowing and proved to be incommunicative. Emergency computed tomography showed global cerebral edema, but normal contrast of the intracranial arteries. Three days later, with normal vigilance restored, the patient underwent magnetic resonance imaging owing to severe headaches. This demonstrated a hyperintense T2/FLAIR signal of the basal ganglia and a hyperintense margin lateral to the lentiform nucleus (Figure). Pseudohypoxic brain swelling, first described in 2003, is a rare complication of cranial and spinal neurosurgical interventions. The pathophysiology has not been completely elucidated, but rapid lowering of cerebrospinal fluid (CSF) pressure/volume in the event of CSF leakage has been postulated. However, pseudohypoxic brain swelling has also been described in spinal interventions without opening of the dura, as in the case depicted here. The outcome ranges from complete regression of the symptoms, as in our patient, to death. In patients with acute neurological symptoms after neurosurgery and global brain swelling or atypical areas of edema in the basal ganglia, the possible presence of pseudohypoxic brain swelling should be considered and distinguished from hypoxic/ischemic events.
Prof. Dr. med. Stephanie Panzer, Abteilung für Radiologie, Neuroradiologie und Interventionelle Radiologie, Berufsgenossenschaftliche Unfallklinik Murnau und Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau und Paracelsus Medizinische Privatuniversität Salzburg, stephanie.panzer@bgu-murnau.de
Dr. med. Michael Bierschneider, Abteilung für Neurochirurgie, Berufsgenossenschaftliche Unfallklinik Murnau
Dr. med. Sebastian Vetter, Abteilung für Radiologie, Neuroradiologie und Interventionelle Radiologie, Berufsgenossenschaftliche Unfallklinik Murnau
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Panzer S, Bierschneider M, Vetter S: Pseudohypoxic brain swelling—a rare complication of neurosurgical interventions. Dtsch Arztebl Int 2024; 121: 400. DOI: 10.3238/arztebl.m2023.0120
