Targeted Anterior Cervical Epidural Blood Patch in a Patient with Spontaneous Intracranial Hypotension

Shekhawat, Ravindra Singh; Yong, Ming Hui; Keong, Si Ying Julienne; Chen, Kunihiko; Too, Chow Wei; Hameed, Shahul

doi:10.1155/2022/8872775

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Scar tissue may gradually form around the clot, reinforcing the seal and preventing future leaks. [ 5 , 13 ] The optimal blood volume for a cervical blood patch may vary depending on the individual case and the location and size of the CSF leak. The procedure can be performed as a high-volume or low-volume procedure usually depending on the physician assessment of the patient condition.…”

Section: Discussionmentioning

confidence: 99%

The cervical blood patch: A therapeutic “miraculous” for cerebrospinal fluid leaks: A case report

Coşarcan,

Erçelen

2024

Medicine

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Rationale: Cerebrospinal fluid (CSF) leaks, arising from abnormal openings in the protective layers surrounding the spinal cord and brain, are a significant medical concern. These leaks, triggered by various factors including trauma, medical interventions, or spontaneous rupture, lead to the draining of CSF—an essential fluid safeguarding the nervous system. A classic symptom of CSF leaks is an incapacitating headache exacerbated by sitting or standing but relieved by lying down. Spontaneous intracranial hypotension (SIH) denotes the clinical condition marked by postural headaches due to spontaneous CSF leakage and hypotension, often misdiagnosed or underdiagnosed. While orthostatic headaches are the hallmark, SIH may manifest with an array of symptoms including nausea, tinnitus, hearing loss, visual disturbances, and dizziness. Treatment options encompass conservative measures, epidural blood patches (EBP), and surgery, with EBP being the primary intervention. Patient Concern: The patient did not express any specific concerns regarding their medical diagnosis. However, they did harbor apprehensions that their condition might necessitate surgical intervention in the future. Diagnosis: The patient had been treated with antibiotics with a pre-diagnosis of sinusitis and was admitted to the neurology department of our hospital when his symptoms failed to improve. Cranial magnetic resonance imaging was interpreted as thickening of the dural surfaces and increased contrast uptake, thought to be due to intracranial hypotension. Cranial MR angiography was normal. Full-spine magnetic resonance imaging revealed a micro-spur at the C2 to 3 level and the T1 to 2 level in the posterior part of the corpus. Interventions: The cervical EBP was performed in the prone position under fluoroscopic guidance. There were no complications. Outcomes: The patient was invited for follow-up 1 week after the procedure, and control examination was normal. Lessons: SIH poses a diagnostic challenge due to its diverse clinical presentation and necessitates precise imaging for effective intervention. Cervical EBP emerges as a promising treatment modality, offering relief and improved quality of life for individuals grappling with this condition. However, clinicians must carefully assess patients and discuss potential risks and benefits before opting for cervical blood patches.

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Section: Discussionmentioning

confidence: 99%

The cervical blood patch: A therapeutic “miraculous” for cerebrospinal fluid leaks: A case report

Coşarcan,

Erçelen

2024

Medicine

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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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Targeted Anterior Cervical Epidural Blood Patch in a Patient with Spontaneous Intracranial Hypotension

Cited by 2 publications

References 14 publications

The cervical blood patch: A therapeutic “miraculous” for cerebrospinal fluid leaks: A case report

The cervical blood patch: A therapeutic “miraculous” for cerebrospinal fluid leaks: A case report

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

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