Abstract
We describe a patient with primary CNS lymphomas, awake despite an extreme ICP elevation. A 48-year-old woman presented with headache since 1 month, and bilateral papillary edema was observed. Magnetic resonance imaging revealed diffuse infiltration around the petrous bone. Following external ventricular drainage (EVD) placement, ICP levels of > 90 mmHg were recorded while the patient was fully awake. Cytology revealed an aggressive primary CNS lymphoma. Cerebrospinal fluid (CSF) drainage at high opening pressure levels was required. We conclude that extreme ICP elevations, treatable by CSF drainage, can be observed without a reduced level of consciousness.
Highlights
Background and importanceMonitoring and treatment of elevated intracranial pressure (ICP) is an integral part of neurosurgical management of acute brain injury, including traumatic brain injury (TBI)
Survival has been observed in TBI patients with ICP ≥ 50 mmHg [14], increased ICP is consistently associated with poor outcome and high mortality [9, 12]
We here describe a case of extremely high ICP of > 90 mmHg in a fully awake and orientated patient with Primary CNS lymphoma (PCNSL)
Summary
Background and importanceMonitoring and treatment of elevated intracranial pressure (ICP) is an integral part of neurosurgical management of acute brain injury, including traumatic brain injury (TBI). We here describe a case of extremely high ICP of > 90 mmHg in a fully awake and orientated patient with PCNSL. A lumbar puncture in the lateral supine position was performed at the department of neurology, despite the presence of papillary edema, since the patient was fully awake, and an increased ICP was not suspected.
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