Milky strawberry-like cerebrospinal fluid secondary to hypertriglyceridemia a rare case report of hemorrhagic stroke

Abstract

Abstract INTRODUCTION: Disorders of lipid metabolism can lead to intracranial hemorrhages as a rare complication of the disease. To our knowledge only 4 case reports were found to have milky pinkish cerebrospinal fluid secondary to severe hypertriglyceridemia. CASE DESCRIPTION: Forty years old Indian male, presented to the emergency department with severe headache, vomiting and decreased level of consciousness. His CT Brain showed intraventricular hemorrhage causing secondary hydrocephalus. His lab investigations revealed very high lipid profile specially triglycerides level (70.19 mmol/L). An external ventricular drain (EVD) was inserted and CSF was milky strawberry-like. CSF analysis revealed high lipid profile as well. Both CTA and DSA were unremarkable for any vascular malformations. The patient was successfully managed through a combined effort of neurosurgery, medical and ICU teams. His serum lipid profile came back to normal, his EVD was removed and a ventriculo-perotineal shunt was inserted. CONCLUSION: The case illustrates the significant high risk for intracranial hemorrhages secondary to hyperlipidemia. Therefore, it may be suggested to obtain a CSF sample via lumbar puncture for example to measure the corresponding CSF lipid profile in patients with extremely high serum levels. This may possibly predict the associated high risk for these devastating intracranial hemorrhages. The guidelines for the serum level at which this has to be performed should be tailored based on multiple randomized multicenter clinical trials. The combined effort of the medical, neurosurgical and ICU teams is the cornerstone in the management of these special cases.