Greater Occipital Nerve Treatment in the Management of Spontaneous Intracranial Hypotension Headache: A Case Report

BackgroundSpontaneous intracranial hypotension occurs due to cerebrospinal fluid leakage from the spinal column, and orthostatic headache is the most common clinical presentation. Recent studies showed that bilateral greater occipital nerve blockade demonstrated clinical efficacy in relieving post-dural puncture headache after caesarean section. CaseA 40-year-old male who presented severe orthostatic headache was consulted to our pain clinic from neurology department. He initially felt a dull nature pain over the whole occipital area which then spread over the frontal and parietal areas. His headache was combined with nausea and vomiting. An epidural blood patch was delayed until final cisternography, and bilateral greater occipital nerve blockade using ultrasound guidance was performed instead. After the blockade, the previously existing headache around the occipital and parietal areas disappeared completely, but mild headache persisted around the frontal area.ConclusionsGreater occipital nerve blockade could be a good therapeutic alternative to improve headache resulting from spontaneous intracranial hypotension.

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Greater Occipital Nerve Block as a Tool to Diagnose Spontaneous Intracranial Hypotension Before Epidural Blood Patch

A & A Practice ◽

10.1213/xaa.0000000000001126 ◽

2020 ◽

Vol 14 (1) ◽

pp. 6-8

Author(s):

Andrea Bortolato ◽

Davide Simonato ◽

Federica Garrì ◽

Joseph Domenico Gabrieli ◽

Giacomo Cester ◽

...

Keyword(s):

Nerve Block ◽

Intracranial Hypotension ◽

Epidural Blood Patch ◽

Spontaneous Intracranial Hypotension ◽

Occipital Nerve ◽

Greater Occipital Nerve Block ◽

Greater Occipital Nerve ◽

Blood Patch ◽

Occipital Nerve Block

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Percutaneous Epidural Hydrogel Sealant for the Treatment of Spontaneous Intracranial Hypotension: A Case Report of Chronic Thoracic Neuralgia and Technical Lessons Learned

Case Reports in Anesthesiology ◽

10.1155/2018/4189518 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Michael G. Hillegass ◽

Samuel F. Luebbert ◽

Maureen F. McClenahan

Keyword(s):

Spinal Cord ◽

Case Report ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Lessons Learned ◽

Injection Velocity ◽

Thoracic Spinal Cord ◽

Ct Guided ◽

Thoracic Spinal ◽

Needle Position

We report a case in which a 34-year-old female with refractory intracranial hypotension headaches due to a spontaneous dural tear was ultimately treated with CT-guided transforaminal epidural placement of a synthetic absorbable sealant (DuraSeal®). The procedure successfully resolved her headaches; however she subsequently developed thoracic neuralgia presumably due to mass effect of the sealant material on the lower thoracic spinal cord and nerve roots. This case report describes the potential for significant spinal cord and nerve root compression as well as the development of chronic neuralgia with the placement of epidural hydrogel and fibrin glue sealants. Careful consideration should be taken into the needle gauge, needle position, injectate volumes, and injection velocity when delivering the sealant to the epidural space. Use of an 18-gauge Tuohy needle with a slow but steady injection pressure, constant patient feedback, and a conservative injectate volume (less than 2 ml per level) may best optimize sealant delivery to minimize the risk of spinal cord compression and neurologic injury.

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