A 64-year-old woman with a history of diabetes mellitus, hypertension and atrial fibrillation anticoagulated with acenocoumarol.
Seen in outpatient clinics due to a clinical picture of impossibility to walk and occasional urinary incontinence, with involvement of superior functions and emotional lability.
Neuroimaging studies showed tetraventricular hydrocephalia.
The suspicion of AHC was decided to place a LLD as a diagnostic test.
After replacing acenocoumarol with low molecular weight heparin a few weeks before, DLE was placed.
When the patient was transferred from the operating room to the hospital ward, drainage was accidentally opened.
Six hours after placement, after draining 240 ml of CSF, the patient developed headaches, nausea, vomiting and sweating, which initially resulted in intracranial hypotension.
The level of consciousness did not deteriorate at any time.
The intensity of the symptoms was determined by an urgent cranial CT which showed the presence of a hematoma in the vermis and left cerebellar hemisphere, with subarachnoid bleeding on the superior surface of the cerebellum
The LED was immediately removed and, given the good clinical status of the patient, it was decided to follow conservative treatment, with good clinical outcome.
Neuroimaging studies (MRI and cerebral angiography) ruled out the existence of underlying pathology.
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The patient remained seated until his previous condition.
Subsequently, a ventriculoperitoneal shunt was performed, resulting in great clinical improvement.
