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Coma Reversed after Spinal Leak Sealed
Neurosurgeons and neuroradiologists at Cedars-Sinai injected a biosynthetic "glue" to seal off a spinal fluid leak and restore a comatose patient to consciousness. It is the first known report of a situation in which a patient's coma was reversed by the injection of glue, according to Wouter I. Schievink, M.D., (pictured below right) director of the Neurovascular Surgery Program and lead author of an article describing the case in a recent issue of The Lancet.

When Los Angeles resident Algis Bliudzius was referred to Cedars-Sinai in a coma after experiencing headaches for two days, physicians first suspected that the blood thinners he was taking had caused hematomas inside the dura, the membrane surrounding the brain and spinal cord. In fact, subdural hematomas did appear on diagnostic CT scans.

But doctors quickly learned that his headaches occurred only when he was upright and resolved when he reclined. Additional diagnostic exams confirmed the new diagnosis: spontaneous intracranial hypotension caused by a small hole in the dura through which spinal fluid leaked. This allowed the brain to sag when the patient changed positions.

A blood patch -- the first, most common treatment approach -- temporarily corrected the problem, and Bliudzius regained consciousness. Forty-eight hours later, however, his condition deteriorated.

Franklin G. Moser, M.D., (pictured below left) director of Clinical and Interventional Neuroradiology at Cedars-Sinai's S. Mark Taper Foundation Imaging Center, then led a team that used CT scan guidance to inject a commonly used glue directly to the site of the leak.

Today Bliudzius is back to leading an active life, walking at Griffith Park and taking three-mile treks around the path at Silver Lake, near his home.

Physicians once thought spontaneous spinal fluid leaks were extremely rare, but Schievink sees several patients a year who come through the Emergency Dept. Symptoms vary, according to Schievink, but they typically include a headache. It may be constant, occurring later in the day or associated with exertion. It may occur when the patient is standing or, in some cases, lying down. There may be no headache at all, or it may be superseded by additional problems, such as coma. Symptoms also may mimic those of dementia or Parkinson's disease.

"Some patients are on bed rest for several months before they are referred for further treatment," Schievink said. "If there is a subdural hematoma -- especially if the patient is comatose -- a neurosurgeon may remove the blood clot. But if they don't recognize that there's an underlying spinal fluid leak and fix it, there's a high chance that the subdural hematomas will come back or get worse."

Citation:The Lancet, April 21, 2007, "Reversal of coma with an injection of glue"