Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF)
leakage. Complications include bilateral subdural hygroma or haematoma and herniation
of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative
treatment is ineffective. We reported the case of a 46-year-old man with a history
of postural headache and dizziness. The patient was treated with bed rest and daily
hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not
resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic
resonance imaging demonstrated diffuse dural enhancement on the postcontrast study,
sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2
level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood
slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented
to people, place, and time. We chose thoracic EBP as first line treatment in consideration
of the risk of cervical EBP such as spinal cord and nerve root compression or puncture,
chemical meningitis. Also we put our patient in Trendelenburg position to make blood
travel towards the site of the leak. Untreated IHS may delay the course of resolution and
affect the patient’s consciousness. Delivery of EBP via an epidural catheter inserted from
the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective
treatment for patients with IHS caused by CSF leak even at C2.
Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage;
epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial
hypotension syndrome; Trendelenburg position
Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding?
