EHMTI-0382. A distal epidural blood patch relieves low CSF pressure headache

Post-dural-puncture headache (PDPH) is a consequence of neuraxial anesthesia, diagnostic lumbar puncture, intrathecal drug delivery systems, or any other technique involving dural trespass. The spinal headache results from a dural puncture that leads to cerebrospinal fluid (CSF) leakage from the subarachnoid space to the epidural space, culminating in intracranial hypotension and development of a low-pressure headache. A key element of PDPH is an increase in pain severity upon a change in position from supine to upright, which corresponds to a gravity-induced influence on CSF pressure dynamics. Age, sex, and design of the needle used correlate with the risk of headache. Sometimes, the headache resolves spontaneously. At other times, conservative treatment or aggressive measures are required to terminate the pain. An autologous epidural blood patch is an established way preventing or treating PDPH. A careful history must be obtained to identify other causes of headache before the blood patch is attempted.

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Computerized tomography-guided epidural blood patch in the treatment of spontaneous low cerebrospinal fluid pressure headache

Acta Anaesthesiologica Scandinavica ◽

10.1034/j.1399-6576.2001.045005649.x ◽

2001 ◽

Vol 45 (5) ◽

pp. 649-651 ◽

Cited By ~ 7

Author(s):

M. Karst ◽

J. Hollenhorst ◽

M. Fink ◽

I. Conrad

Keyword(s):

Cerebrospinal Fluid ◽

Computerized Tomography ◽

Epidural Blood Patch ◽

Fluid Pressure ◽

Cerebrospinal Fluid Pressure ◽

Blood Patch ◽

Pressure Headache

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Peripartum Isolated Cortical Vein Thrombosis in a Mother with Postdural Puncture Headache Treated with an Epidural Blood Patch

Case Reports in Medicine ◽

10.1155/2013/701264 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Etienne Laverse ◽

Sarah Cader ◽

Rajith de Silva ◽

Sanjiv Chawda ◽

Satish Kapoor ◽

...

Keyword(s):

Epidural Blood Patch ◽

Csf Leak ◽

Postdural Puncture Headache ◽

Mri Scan ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis ◽

Blood Patch ◽

Low Pressure Headache ◽

Pressure Headache

A 32-year-old woman presented with low pressure headache 3 days after delivery of her baby. An assessment of postdural puncture headache was made. This was initially treated with analgesia, caffeine, and fluids for the presumed cerebrospinal fluid (CSF) leak. The woman was readmitted two days after her hospital discharge with generalised seizures. A brain scan showed features of intracranial hypotension, and she was treated for CSF leak using an epidural blood patch. Her symptoms worsened and three days later, she developed a left homonymous quadrantanopia. An MRI scan confirmed a right parietal haematoma with evidence of isolated cortical vein thrombosis (ICVT).

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Spontaneous intracranial hypotension combined with subarachnoid hemorrhage: report of 2 cases

10.21203/rs.3.rs-19813/v1 ◽

2020 ◽

Author(s):

Ya Cao ◽

Weinan Na ◽

Hui Su ◽

Xiaolin Wang ◽

Zhao Dong ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Hypotension ◽

Epidural Blood Patch ◽

Brain Mri ◽

Intrathecal Injection ◽

Spontaneous Intracranial Hypotension ◽

Orthostatic Headache ◽

Csf Pressure ◽

Brain Ct ◽

Blood Patch

Abstract Background: Spontaneous intracranial hypotension (SIH) combined with subarachnoid hemorrhage (SAH) has rarely been reported. Herein, we report two patients with SIH who suffered from diffuse non-aneurysmal SAH and expanded the symptom spectrum of SIH.Case report: ① A 55-year-old male was diagnosed with SIH based on orthostatic headache and diffuse pachymeningeal enhancement on brain MRI. One more month later, his headache was exacerbated, and brain CT showed diffuse SAH. Lumber puncture showed bloody CSF with a low CSF pressure of 20 mmH2O after a 30 ml intrathecal injection of saline. The patient was treated with a lumbar epidural blood patch and recovered. ② A 41-year-old male presented with orthostatic headache and nuchal pain. The brain CT scan confirmed the diagnosis of SAH. Brain MRI revealed diffuse dural thickening and bilateral frontoparietal subdural fluid collection. Lumber puncture showed bloody CSF with low CSF pressure. Then, an epidural blood patch was performed with satisfactory results.Conclusion: Dilation and rupture of intracranial venous structures might play significant roles in SIH combined with SAH. We should be alert to SIH patients who develop a new persistent severe headache without relief after lying down or a suddenly changed state of consciousness.

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Successful management of spontaneous intracranial hypotension with epidural blood patch

BMJ Case Reports ◽

10.1136/bcr-2020-240936 ◽

2021 ◽

Vol 14 (8) ◽

pp. e240936

Author(s):

Amanda Ebejer ◽

Mithila Vijay ◽

Thinzar Min

Keyword(s):

Intracranial Hypotension ◽

Epidural Blood Patch ◽

Spontaneous Intracranial Hypotension ◽

Bed Rest ◽

Csf Leak ◽

Neck Stiffness ◽

Postural Headache ◽

Csf Pressure ◽

Blood Patch ◽

Lateral Decubitus

Spontaneous intracranial hypotension (SIH) is characterised by postural headache and a cerebrospinal fluid (CSF) pressure of ≤6 cmH20 measured with the patient in the lateral decubitus position. Other symptoms include tinnitus, altered hearing, diplopia, photophobia, nausea and neck stiffness, and must not have occurred within a month of dural puncture. Symptoms typically remit after normalisation of CSF pressure or successful sealing of the CSF leak. An epidural blood patch (EBP) is a treatment option in those who have not responded to bed rest, fluids, non-steroidal anti-inflammatories or caffeine. We present a case of SIH successfully treated with both conservative measures and EBP. We compare our case with similar cases in the literature and summarise what is known about EBP for SIH to help clinicians take a more informed approach to managing such patients.

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Arachnoiditis, a complication of epidural blood patch for the treatment of low‐pressure headache: A case report and systematic review

Headache The Journal of Head and Face Pain ◽

10.1111/head.14076 ◽

2021 ◽

Author(s):

Linda A. Villani ◽

Kathleen B. Digre ◽

Melissa M. Cortez ◽

Christina Bokat ◽

Ulrich A. Rassner ◽

...

Keyword(s):

Systematic Review ◽

Case Report ◽

Epidural Blood Patch ◽

Low Pressure ◽

Blood Patch ◽

Low Pressure Headache ◽

Pressure Headache

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Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

BMC Neurology ◽

10.1186/s12883-021-02279-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gha-Hyun Lee ◽

Jiyoung Kim ◽

Hyun-Woo Kim ◽

Jae Wook Cho

Keyword(s):

Intracranial Hypotension ◽

Dural Puncture ◽

Epidural Blood Patch ◽

Brain Mri ◽

Spontaneous Intracranial Hypotension ◽

Vein Of Galen ◽

Mri Findings ◽

Post Dural Puncture Headache ◽

Straight Sinus ◽

Blood Patch

Abstract Background Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment. Methods We retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus). Results A total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02). Conclusions Patients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.

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