Chest Pain as a Manifestation of Intracranial Hypotension: Report of Four Cases

Publication date: August 2018

Source: The Journal of Emergency Medicine, Volume 55, Issue 2

Author(s): Adnan I. Qureshi, Danish Kherani, Muhammad A. Waqas, Baljinder Singh, Faisal M. Raja, Shawn S. Wallery

Abstract

Background

Chest pain has not been recognized as a manifestation of intracranial hypotension secondary to cerebrospinal fluid leakage.

Case Report

We report on 4 patients with intracranial hypotension diagnosed by the pattern of headaches, temporal proximity to dural puncture, magnetic resonance imaging findings, and resolution of symptoms after epidural blood patch who presented with chest pain. The chest pain was episodic, located in the sternal and interscapular region for the first 3 patients, with no radiation to any other region and no clear relationship to exertion. The fourth patient had episodic chest pain located in the subclavicular and suprascapular region. Two patients reported dyspnea with chest pain. Underlying coronary artery ischemia was excluded using a combination of the electrocardiogram and cardiac enzyme assays. The pain resolved after epidural blood patch treatment.

Why Should an Emergency Physician Be Aware of This?

Clinicians should be aware of chest pain that can be seen with intracranial hypotension and cerebrospinal leakage to ensure appropriate diagnostic tests and treatment.

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