{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:44:23Z","timestamp":1782492263437,"version":"3.54.5"},"reference-count":30,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["World Neurosurgery"],"published-print":{"date-parts":[[2019,1]]},"DOI":"10.1016\/j.wneu.2018.09.193","type":"journal-article","created":{"date-parts":[[2018,10,5]],"date-time":"2018-10-05T02:28:56Z","timestamp":1538706536000},"page":"e700-e711","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":20,"special_numbering":"C","title":["Disturbed Consciousness and Coma: Diagnosis and Management of Intracranial Hypotension Caused by a Spinal Cerebrospinal Fluid Leak"],"prefix":"10.1016","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7439-9849","authenticated-orcid":false,"given":"Keisuke","family":"Takai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Niimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Hongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoyuki","family":"Umekawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Teranishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomomichi","family":"Kayahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Taniguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.wneu.2018.09.193_bib1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.3174\/ajnr.A0956","article-title":"Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension","volume":"29","author":"Schievink","year":"2008","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.1016\/j.wneu.2018.09.193_bib2","first-page":"470","article-title":"Intracranial hypotension presenting with severe encephalopathy. Case report","volume":"89","author":"Beck","year":"1998","journal-title":"J\u00a0Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib3","first-page":"615","article-title":"Intracranial hypotension producing reversible coma: a systematic review, including three new cases","volume":"117","author":"Loya","year":"2012","journal-title":"J\u00a0Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib4","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1007\/s12028-012-9800-3","article-title":"Stroke and death due to spontaneous intracranial hypotension","volume":"18","author":"Schievink","year":"2013","journal-title":"Neurocrit Care"},{"key":"10.1016\/j.wneu.2018.09.193_bib5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/0333102412466963","article-title":"Management of patients with spontaneous intracranial hypotension causing altered level of consciousness: report of two cases and review of literature","volume":"33","author":"Ghavanini","year":"2013","journal-title":"Cephalalgia"},{"key":"10.1016\/j.wneu.2018.09.193_bib6","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1097\/00006123-200209000-00045","article-title":"Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report","volume":"51","author":"Binder","year":"2002","journal-title":"Neurosurgery"},{"key":"10.1016\/j.wneu.2018.09.193_bib7","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1097\/00000539-200204000-00034","article-title":"Blood patch therapy for spontaneous intracranial hypotension: safe performance after epidurography in an unconscious patient","volume":"94","author":"Terajima","year":"2002","journal-title":"Anesth Analg"},{"key":"10.1016\/j.wneu.2018.09.193_bib8","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1080\/02688690310001611251","article-title":"Spontaneous intracranial hypotension causing confusion and coma: a headache for the neurologist and the neurosurgeon","volume":"17","author":"Whiteley","year":"2003","journal-title":"Br J Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib9","first-page":"E204","article-title":"Spontaneous intracranial hypotension resulting in coma: case report","volume":"59","author":"Sayer","year":"2006","journal-title":"Neurosurgery"},{"key":"10.1016\/j.wneu.2018.09.193_bib10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10072-006-0566-2","article-title":"A\u00a0complicated case of intracranial hypotension: diagnostic and management strategies","volume":"27","author":"Akkawi","year":"2006","journal-title":"Neurol Sci"},{"key":"10.1016\/j.wneu.2018.09.193_bib11","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/j.1468-2982.2007.01259.x","article-title":"Transtentorial herniation with cerebral infarction and duret haemorrhage in a patient with spontaneous intracranial hypotension","volume":"27","author":"Chi","year":"2007","journal-title":"Cephalalgia"},{"key":"10.1016\/j.wneu.2018.09.193_bib12","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.3174\/ajnr.A1157","article-title":"Emergent image-guided treatment of a large CSF leak to reverse \u201cin-extremis\u201d signs of intracranial hypotension","volume":"29","author":"Aghaei Lasboo","year":"2008","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.1016\/j.wneu.2018.09.193_bib13","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.clineuro.2009.06.001","article-title":"Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in the Trendelenburg position pre-medicated with acetazolamide","volume":"111","author":"Ferrante","year":"2009","journal-title":"Clin Neurol Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib14","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1007\/s12028-009-9323-8","article-title":"Coma from worsening spontaneous intracranial hypotension after subdural hematoma evacuation","volume":"12","author":"Dhillon","year":"2010","journal-title":"Neurocrit Care"},{"key":"10.1016\/j.wneu.2018.09.193_bib15","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1017\/S0317167100011070","article-title":"Spontaneous intracranial hypotension: case series of rare clinical presentations","volume":"38","author":"Chaudhary","year":"2011","journal-title":"Can J Neurol Sci"},{"key":"10.1016\/j.wneu.2018.09.193_bib16","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2176\/nmc.oa.2015-0032","article-title":"Chronic subdural hematoma associated with spontaneous intracranial hypotension: therapeutic strategies and outcomes of 55 cases","volume":"56","author":"Takahashi","year":"2016","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.1016\/j.wneu.2018.09.193_bib17","doi-asserted-by":"crossref","first-page":"e369","DOI":"10.7205\/MILMED-D-14-00141","article-title":"Spontaneous intracranial hypotension: Trendelenberg just may be the answer","volume":"180","author":"Koch","year":"2015","journal-title":"Mil Med"},{"key":"10.1016\/j.wneu.2018.09.193_bib18","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1213\/XAA.0000000000000385","article-title":"Spontaneous intracranial hypotension: an etiology for consciousness disorder and coma","volume":"7","author":"Collange","year":"2016","journal-title":"A\u00a0A Case Reports"},{"key":"10.1016\/j.wneu.2018.09.193_bib19","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.wneu.2017.01.123","article-title":"Spontaneous intracranial hypotension: a review and introduction of an algorithm for management","volume":"101","author":"Davidson","year":"2017","journal-title":"World Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib20","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1177\/0333102413485658","article-title":"The International Classification of Headache Disorders, 3rd edition","volume":"33","year":"2013","journal-title":"Cephalalgia"},{"key":"10.1016\/j.wneu.2018.09.193_bib21","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3171\/2014.5.SPINE13549","article-title":"Leakage detection on CT myelography for targeted epidural blood patch in spontaneous cerebrospinal fluid leaks: calcified or ossified spinal lesions ventral to the thecal sac","volume":"21","author":"Yoshida","year":"2014","journal-title":"J\u00a0Neurosurg Spine"},{"key":"10.1016\/j.wneu.2018.09.193_bib22","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.wneu.2017.07.168","article-title":"Targeted epidural blood patch under O-arm\u2013guided stereotactic navigation in patients with intracranial hypotension associated with a spinal cerebrospinal fluid leak and ventral dural defect","volume":"107","author":"Takai","year":"2017","journal-title":"World Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib23","doi-asserted-by":"crossref","first-page":"400","DOI":"10.2214\/AJR.12.8611","article-title":"Intracranial hypotension: improved MRI detection with diagnostic intracranial angles","volume":"200","author":"Shah","year":"2013","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.wneu.2018.09.193_bib24","doi-asserted-by":"crossref","first-page":"751","DOI":"10.3171\/2016.11.SPINE16488","article-title":"Superficial siderosis of the central nervous system associated with intraspinal hemorrhage from ventral thoracic epidural veins and a ventral spinal CSF leak: case report","volume":"26","author":"Takai","year":"2017","journal-title":"J\u00a0Neurosurg Spine"},{"key":"10.1016\/j.wneu.2018.09.193_bib25","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1159\/000381667","article-title":"Spontaneous intracranial hypotension manifesting as a unilateral subdural hematoma with a marked midline shift","volume":"7","author":"Inamasu","year":"2015","journal-title":"Case Rep Neurol"},{"key":"10.1016\/j.wneu.2018.09.193_bib26","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3340\/jkns.2016.59.1.69","article-title":"Extended pneumocephalus after drainage of chronic subdural hematoma associated with intracranial hypotension: case report with pathophysiologic consideration","volume":"59","author":"Shin","year":"2016","journal-title":"J\u00a0Korean Neurosurg Soc"},{"key":"10.1016\/j.wneu.2018.09.193_bib27","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1093\/brain\/awm101","article-title":"Spontaneous intracranial hypotension with deep brain swelling","volume":"130","author":"Savoiardo","year":"2007","journal-title":"Brain"},{"key":"10.1016\/j.wneu.2018.09.193_bib28","first-page":"1089","article-title":"Spontaneous intracranial hypotension and immediate improvement following epidural blood patch placement demonstrated by intracranial pressure monitoring. Case report","volume":"106","author":"Zada","year":"2007","journal-title":"J\u00a0Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib29","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.wneu.2018.07.148","article-title":"Intracranial hypotension with coma: microsurgical repair of a spinal ventral dural tear and drainage of subdural hematoma with intracranial pressure monitoring","volume":"118","author":"Takai","year":"2018","journal-title":"World Neurosurg"},{"key":"10.1016\/j.wneu.2018.09.193_bib30","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1212\/WNL.0000000000002986","article-title":"A\u00a0classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink","year":"2016","journal-title":"Neurology"}],"container-title":["World Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1878875018322484?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1878875018322484?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T08:12:27Z","timestamp":1761811947000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1878875018322484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":30,"alternative-id":["S1878875018322484"],"URL":"https:\/\/doi.org\/10.1016\/j.wneu.2018.09.193","relation":{},"ISSN":["1878-8750"],"issn-type":[{"value":"1878-8750","type":"print"}],"subject":[],"published":{"date-parts":[[2019,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Disturbed Consciousness and Coma: Diagnosis and Management of Intracranial Hypotension Caused by a Spinal Cerebrospinal Fluid Leak","name":"articletitle","label":"Article Title"},{"value":"World Neurosurgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.wneu.2018.09.193","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2018 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}