Pearls & Oy-sters: The Price of Patency: Intractable Headache Subsequent to Fourth Ventricular Recanalization.
Saif D Salman, David A Miller, Chistopher L Kramer et al.
✦ AI-curated · Sources linked
Case in brief
A 61-year-old woman with secondary fourth ventricular hemorrhage was treated using an IRRAflow active irrigation and drainage system. The fourth ventricle recanalized and cisternal subarachnoid blood cleared, but she developed an intractable headache. Imaging, intracranial pressure, and laboratory investigations were normal. The report identifies caudal sac inflammation as the suspected explanation for the persistent headache despite these reassuring findings.
What made this case unusual
The headache emerged after fourth ventricular recanalization and persisted despite normal imaging, intracranial pressure, and laboratory results; caudal sac inflammation was proposed as a hidden culprit.
Diagnostic / clinical pearl
Persistent headache after fourth ventricular recanalization may reflect caudal sac inflammation even when imaging, intracranial pressure, and laboratory investigations are normal.