Efficacy of Epidural Blood Patches for Spontaneous Low-Pressure Headaches: A Case Series

Abstract

Patients with a spontaneous cerebrospinal fluid leak, normally at a spinal level, typically present with low-pressure headache. In refractory cases, an epidural blood patch may be attempted. We aimed to assess the efficacy of lumbar epidural blood patching in spontaneous, low-pressure headaches. Methods We retrospectively analysed notes of patients who had an epidural blood patch performed for spontaneous low-pressure headaches in a single centre. Information regarding demographics, radiology and clinic follow-up was extracted from an electronic patient record system. Questionnaires regarding outcome were sent to patients a minimum of 6 months post-procedure. All patients received an epidural blood patch in the lumbar region irrespective of the site of cerebrospinal fluid leak. Results Sixteen patients who underwent lumbar epidural blood patching were analysed (11 female; mean age 43 years). The site of cerebrospinal fluid leak was evident in only 3/16 patients. Thirteen patients attended clinic follow-up; three reported complete headache resolution, four reported improvement in intensity or frequency and six described no change. Five of eight questionnaire respondents reported reduction in pain, and in these responders, mean headache severity improved from 9/10 to 3/10. Five of eight patients returning follow-up questionnaires reported sustained improvement in headache symptoms. Conclusion Epidural blood patch procedures can provide sustained improvement in headache symptoms in selected patients with spontaneous intracranial hypotension, but an untargeted approach has a lower success rate than reported in other case series.

Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome

“…The proportion of female individuals was 63% (95% CI, 60%-66%; I 2 = 52.4). Connective tissue disorders, spinal pathologies (ie, osteophytes, disc prolapse, and discogenic micro spurs) and bariatric surgery were identified as risk factors for SIH and reported by several authors …”

“…Connective tissue disorders, spinal pathologies (ie, osteophytes, disc prolapse, and discogenic micro spurs) and bariatric surgery were identified as risk factors for SIH and reported by several authors. [13][14][15][16][17][18][19][20][21][22][23] Table 1…”

“…Connective tissue disorders, spinal pathologies (ie, osteophytes, disc prolapse, and discogenic micro spurs) and bariatric surgery were identified as risk factors for SIH and reported by several authors. [13][14][15][16][17][18][19][20][21][22][23] Table 1 and Figure 1 show a summary of the clinical characteristics of 1694 patients with SIH (33 articles). The duration of symptoms at the time of diagnosis and/or treatment was variable ranging from 1 day to 19.7 years, 24,25 with a pooled estimated mean of 31.7 days (95% CI, 24.8-38.5; I 2 = 97.4%).…”

Epidural blood patch in the treatment of severe post dural puncture headache after spinal anesthesia: A rare case report

“…Five of the eight questionnaire respondents experienced less pain, and the mean headache severity dropped from 9/10 to 3/10. Five of the eight patients who returned follow-up questionnaires reported that their headache symptoms had improved over time [17] .…”

The importance of repeat digital subtraction myelography in the diagnosis of cryptogenic CSF-venous fistula causing spontaneous intracranial hypotension

“…Localization of the site is most important not only for surgical planning but also useful to target the EBP which in turn leads to better outcomes. 4 Traditional avenues of leak site localization have been generally limited to CT and MR myelography and in some centers, radionuclide myelography. Conventional CT and MR myelography result in static images that are adequately diagnostic in only 45-54% of cases.…”