{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T02:16:09Z","timestamp":1776910569441,"version":"3.51.2"},"reference-count":12,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,9]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Cerebrospinal fluid hypotension, or \u201cbrain sag,\u201d is a recently described phenomenon most commonly seen following craniotomy for the clipping of ruptured aneurysms along with preoperative lumbar drain placement. The clinical features and CT findings have been previously described. Clinical presentation can be similar to and often mistaken for cerebral vasospasm. In this study, the authors report on the angiographic findings in patients with brain sag.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Five cases of brain sag were diagnosed (range 1\u20134 days) after the surgical treatment of ruptured aneurysms at the University of Illinois at Chicago. All patients met the clinical and CT criteria for brain sag. Admission cerebral angiograms and subsequent angiograms during symptoms of brain sag were obtained in all patients. In 3 patients, angiography was performed after the resolution of symptoms.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In all 5 patients, the level of the basilar artery apex was displaced inferiorly with respect to the posterior clinoid processes during brain sag. This displacement was significant enough to create a noticeable kink in the basilar artery (\u201ccobra sign\u201d) in 3 patients. Other angiographic findings included foreshortening or kinking of the intracranial vertebral artery. In all patients, the posterior cerebral arteries were displaced medially and inferiorly. Three patients were treated for simultaneous severe radiological vasospasm. In 4 patients, the brain sag was recognized, and the patients' conditions improved when they were placed flat or in the Trendelenburg position, at times combined with an epidural blood patch. Patients with follow-up angiography studies after the symptoms had resolved displayed a reversal of the angiographic features.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Brain sag appears to be associated with characteristic angiographic features. Recognizing these features may help to diagnose brain sag as the cause of neurological deterioration in this patient population.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.4.jns101168","type":"journal-article","created":{"date-parts":[[2011,5,27]],"date-time":"2011-05-27T14:16:59Z","timestamp":1306505819000},"page":"586-591","source":"Crossref","is-referenced-by-count":13,"title":["Angiographic features of \u201cbrain sag\u201d"],"prefix":"10.3171","volume":"115","author":[{"given":"Ali","family":"Alaraj","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troy","family":"Munson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian R.","family":"Herrera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Aletich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fady T.","family":"Charbel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sepideh","family":"Amin-Hanjani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns101168","series-title":"J Neurol Neurosurg Psychiatry","first-page":"992","article-title":"Brain stem and cerebellar dysfunction after lumbar spinal fluid drainage: case report","volume":"74","author":"Bloch","year":"2003"},{"key":"b2-jns101168","series-title":"Surg Neurol","first-page":"338","article-title":"The safety of intraoperative lumbar subarachnoid drainage for acutely ruptured intracranial aneurysm: technical note","volume":"48","author":"Connolly","year":"1997"},{"key":"b3-jns101168","series-title":"J Craniofac Surg","first-page":"145","article-title":"Neurological deterioration after lumbar cerebrospinal fluid drainage","volume":"3","author":"Francel","year":"1992"},{"key":"b4-jns101168","series-title":"J Neurosurg","first-page":"348","article-title":"Focal neurological deficits secondary to intraoperative CSF drainage: successful resolution with an epidural blood patch. Report of two cases","volume":"45","author":"Guido","year":"1976"},{"key":"b5-jns101168","series-title":"Neurology","first-page":"157","article-title":"Sinking brain syndrome: craniotomy can precipitate brainstem herniation in CSF hypovolemia","volume":"62","author":"Kelley","year":"2004"},{"key":"b6-jns101168","series-title":"Neurosurgery","first-page":"286","article-title":"Herniation secondary to critical postcraniotomy cerebrospinal fluid hypovolemia","volume":"57","author":"Komotar","year":"2005"},{"key":"b7-jns101168","series-title":"Neurosurgery","first-page":"284","article-title":"Critical postcraniotomy cerebrospinal fluid hypovolemia: risk factors and outcome analysis","volume":"59","author":"Komotar","year":"2006"},{"key":"b8-jns101168","series-title":"Diagnostic Cerebral Angiography","first-page":"313","article-title":"Neoplasms and mass effect","author":"Osborn","year":"1999"},{"key":"b9-jns101168","series-title":"Radiology of the Skull and Brain","first-page":"2671","article-title":"Brain herniations II. Angiography","author":"Perret","year":"1974"},{"key":"b10-jns101168","series-title":"Neurosurgery","first-page":"148","article-title":"Intracranial hypotension after intraoperative lumbar cerebrospinal fluid drainage","volume":"52","author":"Samadani","year":"2003"},{"key":"b11-jns101168","series-title":"Neurosurgery","first-page":"880","article-title":"Prolonged lumbar spinal drainage after the resection of tumors of the skull base: a cautionary note","volume":"28","author":"Snow","year":"1991"},{"key":"b12-jns101168","series-title":"Neurosurgery","first-page":"119","article-title":"Anterior communicating artery aneurysms","volume":"48","author":"Solomon","year":"2001"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/3\/article-p586.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/3\/article-p586.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/3\/article-p586.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T02:20:36Z","timestamp":1679883636000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/3\/article-p586.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,9]]},"references-count":12,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2011.4.jns101168","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,9]]}}}