Management of Spontaneous Intracranial Hypotension During Pregnancy: A Case Series

Abstract

Background Spontaneous intracranial hypotension (SIH) is a rare condition resulting from cerebrospinal fluid (CSF) volume depletion, nearly always from spontaneous CSF leaks. CSF pressure in SIH is usually normal; low CSF pressure is found in a substantial minority of patients. SIH is uncommonly described in pregnancy. Case Series Five women with SIH during pregnancy have been conservatively treated adopting bed rest and overhydration. After prolonged conservative treatment, only 1 patient showed complete symptoms resolution. A rare SIH complication as cerebral venous thrombosis has been reported in 1 case. All 4 remaining patients had lumbar epidural blood patch (EBP) with symptoms disappearance. Conclusions EBP might be proposed to SIH patients also during pregnancy and after a brief period (~10 days) of ineffective conservative treatment, because it could allow faster symptoms improvement and complete recovery. Furthermore, EBP would avoid prolonged bed rest with the risk of SIH severe complications.

Management of Labor and Anesthesia in a Patient With a History of Spontaneous Intracranial Hypotension: A Case Report With Literature Review

“…Both patients underwent vaginal delivery without SIH recurrence [ 11 ]. Ferrante et al described five patients who developed SIH during pregnancy and delivered successfully following treatment; among them, two delivered vaginally while three underwent CS [ 14 ]. These reports indicated successful delivery following treatment for SIH without its recurrence; however, the number of reported cases is small (n = 12), and the anesthesia method was only described in two cases.…”

“…A literature search of Pubmed, Cochrane Library, and Embase databases from 1980 to 2022 using the following search terms: "spontaneous intracranial hypotension," "cerebrospinal fluid," and "pregnancy" yielded 13 reports of SIH development during pregnancy and delivery. Table 1 summarizes the patient characteristics and the delivery and anesthesia methods in these patients [5,[9][10][11][12][13][14][15]. among them, two delivered vaginally while three underwent CS [14].…”

“…Table 1 summarizes the patient characteristics and the delivery and anesthesia methods in these patients [5,[9][10][11][12][13][14][15]. among them, two delivered vaginally while three underwent CS [14]. These reports indicated successful delivery following treatment for SIH without its recurrence; however, the number of reported cases is small (n = 12), and the anesthesia method was only described in two cases.…”

A notable improvement in spontaneous intracranial hypotension (SIH) after delivery in a pregnant woman: A case report

“…Epidural blood patch (EBP) is another treatment available for SIH that has shown a significant impact on the recovery of patients which declared in several studies [17 , 18] . EBP was not performed for our patient due to the sensitive location of the Dural defect.…”