Epidural blood patch for spontaneous intracranial hypotension (SIH): a report of two cases

Arumugam, Ganesh; Ram, Sudha; P, Bhaskar Naidu; Kumaravelu, S

doi:10.1177/0049475520933140

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…5 The success rate of EBP injections ranges from 30 to 70%, but the initial EBP is reported with a success rate of 93%, including partial and complete relief of symptoms. 4,5,13 Thus, EBP injection requires further validation and a proper guideline in the management of SIH with single and multiple spinal leaks.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Saranraj

Giridharan

Nathan

et al. 2023

Indian Journal of Neurosurgery

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Introduction Spontaneous intracranial hypotension (SIH) is a misdiagnosed condition characterized by low cerebrospinal fluid (CSF) volume and an orthostatic headache that worsens with upright posture due to CSF leak at spinal dural defects. SIH due to CSF leak at multiple spinal levels is a rare condition, and only a few cases have been reported in the literature. Here, we report a case of SIH with a CSF leak at multiple spinal levels. The treatment options and efficacy of epidural blood patch (EBP) injection were discussed in this article. Case Report A 36-year-old man presented with complaints of orthostatic headache for 2 months and a computed tomography myelogram demonstrated CSF leaks at multiple spinal levels through the dural defects at C5-C6, C6-C7, C7-T1, T1-T2 levels, and at L1, L2, L3, and L4 vertebral levels on the left side. He was managed with a targeted EBP injection and he improved symptomatically within 24 hours of the EBP injection. Summary SIH is an entity that results from CSF leakage, often through spinal dural defects due to mechanical tear by osteophyte complex, disc prolapse, connective tissue disorders, CSF-venous fistula, and leaking meningeal diverticula. SIH can result from single or multiple dural leaks, but spinal leaks at multiple levels are uncommon. To the best of our knowledge, a total number of 163 cases have been reported in the literature so far. With good success rates, targeted EBP injection with autologous blood is an effective treatment option for both single-level and multiple-level spinal leaks.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Saranraj

Giridharan

Nathan

et al. 2023

Indian Journal of Neurosurgery

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Thunderclap headache revealing dural tears with symptomatic intracranial hypotension: Report of two cases

et al. 2023

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Cerebrospinal fluid (CSF) leakage is considered the cause of spontaneous intracranial hypotension (SIH), an important etiology for new daily persistent headaches and a potentially life-threatening condition. Minor traumatic events rarely lead to CSF leakage, contrasting with iatrogenic interventions such as a lumbar puncture or spinal surgery, which are commonly complicated by dural tears. Most meningeal lesions are found in the cervicothoracic region, followed by the thoracic region, and rarely in the lumbar region, and extremely rarely in the sacral region. We describe two patients admitted to our hospital for severe headaches aggravated in the orthostatic position, with a recent history of minor trauma and sustained physical effort, respectively. In the first case, a bone fragment pierced an incidental congenital meningocele creating a dural fistula. An extensive extradural CSF collection, spanning the cervicothoracic region (C4–T10), was described in the second case. In both patients, the clinical evolution was favorable under conservative treatment.

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Epidural blood patch for spontaneous intracranial hypotension (SIH): a report of two cases

Cited by 2 publications

References 17 publications

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Spontaneous Intracranial Hypotension Due to CSF Leak at Multiple Spinal Levels—A Case Report and Literature Review

Thunderclap headache revealing dural tears with symptomatic intracranial hypotension: Report of two cases

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