Clinical Status of Patients with Cerebrospinal Fluid Hypovolemia Treated with an Epidural Blood Patch

Abstract

Objective: Use of an epidural self-blood patch (EBP) is the most effective form of therapy for patients with cerebrospinal fluid (CSF) hypovolemia. However, even if the symptoms are resolved, other clinical aspects of this condition frequently prevent patients resuming social activity. In the present study, we investigated the clinical course of patients with CSF hypovolemia after treatment with an EBP to assess the factors affecting return to work or school, and considered the treatment of patients with progressive chronic subdural hematoma. Patients and Results: We investigated a group of 10 patients with CSF hypovolemia. After initial application of an EBP, 8 of these patients were completely relieved of postural headache and associated symptoms, and the other 2 recovered after a second application. However, 3 patients who had cervical spondylosis or psychosis were still unable to return to work or school. Two patients who were forced to retire have potential for rehabilitation after EBP. One patient has recovered from the illness, but could not return to school due to persistent medical history of psychosis. These patients had suffered symptoms for a long period before EBP (mean, 17.8 months; range 7 months to 3 years) relative to those who were able to resume social activity (mean, 2.0 months; range 7 days to 5 months) (P < 0.05). Three had progressive bilateral chronic subdural hematoma. One of these patients required emergency burr-hole drainage to resolve the neurological deterioration. Conclusions: Both physicians and patients need to be aware of CSF hypovolemia, and the fact that it requires appropriate treatment without delay. While application of an EBP is a fundamentally important therapy even for patients with hematoma, careful follow-up is required for patients showing marked neurological deterioration or an increasing hematoma volume with a brain midline shift, and burr-hole drainage must sometimes be considered in combination with EBP. T. Nishizaki et al.

Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma

“…The standard management strategy for SDH generally involves decompression surgery or conservative care with close observation depending on the age of the hematoma, degree of the midline shift, clot thickness, and neurological status [ 4 , 18 ]. However, a different treatment strategy is necessary for the sealing of CSF leaks in patients with SIH-induced SDH [ 19 , 20 , 21 , 22 ]. Therefore, for optimal treatment in some patients with SDH, recognition of the possibility of SIH as a cause of SDH is important [ 8 ].…”