Postoperative intracranial hypotension-associated venous congestion: the lentiform rim sign

Introduction

Postoperative intracranial hypotension-associated venous congestion (PIHV) or pseudohypoxic brain swelling (PHBS), first described in 2003, is a rare but potentially fatal acute complication following otherwise uneventful intracranial or spinal surgery mainly with liquor leakage or use of suction drainage [Van Roost D et al. Neurosurgery 2003; 53: 1315–1322]. The patients suffer from an unexpected impairment of consciousness, seizures, and brainstem dysfunction. It is supposed that a rapid loss of cerebrospinal fluid (CSF) causes brain sagging which may compromise the main intracranial deep venous structures through shear forces. Therefore, venous ischemia, infarction, and bleeding due to venous congestion are likely consequences [Van Roost D et al. Neurosurgery 2003; 53: 1315–1322].

Publication History

Received: 08 December 2022

Accepted after revision: 22 March 2023

Article published online:
09 May 2023