Spontaneous intracranial hypotension sih, also termed csf hypovolaemia, results from csf leakage from the spinal column mokri, 20. Epidural blood patch for spontaneous intracranial hypotension with. After admitting to our hospital, he was diagnosed with intracranial hypotension caused by incidental durotomy during surgery. This case report describes the successful treatment of chronic headache from intracranial hypotension with bilateral transforaminal tf lumbar epidural blood patches ebps. Early epidural blood patch in spontaneous intracranial hypotension. Spontaneous intracranial hypotension sih is an important cause of new daily persistent headache. Rebound intracranial hypertension is a complication of epidural blood patching for treatment of intracranial hypotension characterized by increased intracranial pressure, resulting in potentially severe headache, nausea, and vomiting.
In some cases, spinal csf leaks can lead to a descent of the cerebellar tonsils into the spinal canal, similar to a chiari malformation. Intracranial hypotension radiology reference article. When successful, headaches resolve within 72 hours of intervention 12. B t2weighted images from a cervical spine mri myelogram showing a fluid collection in the.
Treatment with epidural blood patch for iatrogenic. Blood patch archives csf leak association cerebrospinal fluid. Intracranial hypotension is a condition in which there is negative pressure within the brain cavity. Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension. He had not had a headachefree day in more than years. It is characterised by increased intracranial pressure, resulting in potentially severe headache, nausea, and vomiting. Intracranial hypotension with severe neurological symptoms resolved by epidural blood patch volume 31 issue 4 philip w. In this case report, we have discussed the diagnostic methods of spontaneous intracranial hypotension and the importance of an epidural blood patch for its treatment in the light of the literature. Spontaneous intracranial hypotension practical neurology. Postepidural blood patch precautions guidance standard. Transforaminal blood patch for the treatment of chronic. Spontaneous intracranial hypotension is caused by idiopathic spinal csf leak. Subdural effusions can resolve within a few days to weeks. After failure of conservative treatment, a targeted computer.
Intracranial hypotension with severe neurological symptoms. Intracranial hypotension often results from a cerebrospinal fluid csf leak. Download citation epidural blood patch and spontaneous intracranial hypotension spontaneous intracranial hypotension is an uncommon entity and this is recognized as the cause of postural headache. Blind epidural blood patch for spontaneous intracranial. Spontaneous, sometimes following exertion such as swinging a golf club. Epidural blood or fibrin patch is the treatment of choice for sih. Spontaneous intracranial hypotension with typical orthostatic headache can.
Successful treatment was performed with ctguided blood patch at the leakage site after the patient had failed 2 lumbar blood patches. Intracranial subdural hematoma coexisting with improvement in. Factors predicting response to the first epidural blood patch in. Spontaneous intracranial hypotension sih was originally described by schaltenbrand in 1938 and is a syndrome featuring low cerebrospinal fluid csf pressure resulting from csf leakage without any history of dural puncture, surgery, or penetrating trauma. Patients with severe signs of postsurgical intracranial hypotension may necessitate immediate treatment with epidural blood patching and placement in the reverse trendelenburg position, as the defect in those cases are likely localized in the lumbar spine e. Rebound intracranial hypertension sometimes called rebound high pressure and colloquially shortened to rhp can be a complication of epidural blood patching or surgery performed to resolve a csf leak. The headache was rapidly relieved and later the sdh was completely absorbed. After two procedures of epidural blood patch, the patients became asymptomatic. Simultaneous epidural blood patches at different intervertebral. The patient is a 65yearold male with chronic postural headaches. An epidural blood patch is thought to be the most effective treatment, but a. A 36yearold male had spontaneous intracranial hypotension sih. A generous csf leak was identified at c2 on ct myelography. A complete cure was obtained in 77% of patients after one 57% or two 20% ebps.
Evaluation and treatment of spontaneous intracranial hypotension. Epidural blood patch and spontaneous intracranial hypotension. Editorspontaneous intracranial hypotension sih is an important, but rare. Aftercare following a csf leak or csf leak repair csf.1115 369 176 1116 222 127 1520 264 440 1203 690 254 1504 1304 1324 1519 948 309 254 456 132 354 543 217 785 1055 61 81 787 219