scholarly journals Greater occipital nerve blockade using ultrasound guidance for the headache of spontaneous intracranial hypotension - A case report -

2021 ◽  
Author(s):  
Ji Hee Hong ◽  
Ho Woo Lee ◽  
Yong Ho Lee
Keyword(s):  
Intracranial Hypotension ◽  
Ultrasound Guidance ◽  
Spontaneous Intracranial Hypotension ◽  
Pain Clinic ◽  
Orthostatic Headache ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Blockade ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Blood Patch

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.

scholarly journals A spontán intracranialis hypotensio diagnosztikája mágneses rezonanciás képalkotással

2021 ◽  
Vol 162 (7) ◽  
pp. 246-251
Author(s):  
Máté Magyar ◽  
Nóra Luca Nyilas ◽  
Dániel Bereczki ◽  
György Bozsik ◽  
Gábor Rudas ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Brain Mri ◽  
Spontaneous Intracranial Hypotension ◽  
Orthostatic Headache ◽  
Definitive Treatment ◽  
Cerebrospinal Fluid Leakage ◽  
Spinal Diseases ◽  
Minor Trauma ◽  
Blood Patch

Összefoglaló. A klasszikus esetben ortosztatikus fejfájást okozó, spontán intracranialis hypotensiót az esetek túlnyomó többségében a gerinccsatornában, annak nyaki-háti átmenetében, illetve a háti szakaszán található liquorszivárgás okozza. Meglévő kötőszöveti betegség, degeneratív gerincbetegségek, illetve kisebb traumák szerepet játszhatnak a szivárgás kialakulásában. Az ortosztatikus fejfájás létrejöttében szerepet játszhat a meningealis szerkezetek, érzőidegek és hídvénák vongálódása. A klasszikus pozicionális, ortosztatikus fejfájásban szenvedő betegek körében gondolni kell a spontán intracranialis hypotensio lehetőségére, és az agykoponya, illetve a gerinc kontrasztanyaggal végzett mágneses rezonanciás vizsgálata (MRI) javasolt. A kontrasztanyaggal végzett koponya-MRI-vel klasszikus esetben diffúz, nem nodularis, intenzív, vaskos pachymeningealis kontrasztanyag-halmozás, kitágult vénássinus-rendszer, subduralis effusiók és az agytörzs caudalis diszlokációja („slumping”) látható. Fontos azonban szem előtt tartani, hogy az esetek 20%-ában ezen eltérések nem detektálhatók. Jó minőségű, randomizált, kontrollált vizsgálatok nem történtek, a kezelés hagyományokon alapul. Kezdetben általában konzervatív terápiát alkalmaznak (ágynyugalom, koffein- és folyadékbevitel), ennek hatástalansága esetén epiduralis sajátvér-injekció, epiduralis fibrinragasztó-injektálás, illetve sebészi terápia jöhet szóba. Orv Hetil. 2021; 162(7): 246–251. Summary. Spontaneous intracranial hypotension, the classic feature of which is orthostatic headache, is most commonly caused by a cerebrospinal fluid leakage at the level of the spinal canal, in most cases at the thoracic level or cervicothoracic junction. Underlying connective tissue disorders, minor trauma, degenerative spinal diseases may play a role in the development of cerebrospinal fluid leaks. Traction on pain-sensitive intracranial and meningeal structures, particularly sensory nerves and bridging veins, may play a role in the development of orthostatic headache. In the case of patients with classic orthostatic headache, the possibility of spontaneous intracranial hypotension should be considered, and if suspected, brain magnetic resonance imaging (MRI) with gadolinium and additional spine MRI are recommended. Diffuse, non-nodular, intense, thick dural enhancement, subdural effusions, engorgement of cerebral venous sinuses, sagging of the brain are typical features on brain MRI, which, however, remain normal in up to 20 percent of patients with spontaneous intracranial hypotension. Unfortunately, no randomized clinical trials have evaluated the effectiveness of the various treatment strategies and no definitive treatment protocols have been established. In clinical practice, the first-line treatment of spontaneous intracranial hypotension is conservative (bed rest, caffeine and fluid intake). If conservative therapy is not effective, epidural blood patch, epidural fibrin glue, or surgical repair should be considered. Orv Hetil. 2021; 162(7): 246–251.

Application of IHS Criteria to Headache Attributed to Spontaneous Intracranial Hypotension in a Large Population

Cephalalgia ◽  
2009 ◽  
Vol 29 (4) ◽  
pp. 418-422 ◽  
Author(s):  
E Mea ◽  
L Chiapparini ◽  
M Savoiardo ◽  
A Franzini ◽  
D Grimaldi ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
International Headache Society ◽  
Large Population ◽  
Spontaneous Intracranial Hypotension ◽  
Final Diagnosis ◽  
Orthostatic Headache ◽  
Cerebral Magnetic Resonance Imaging ◽  
Blood Patch ◽  
Standing Up ◽  
Ihs Criteria

We applied the recent International Headache Society (IHS) criteria for headache related to spontaneous intracranial hypotension (SIH) to 90 consecutive patients with a final diagnosis of SIH confirmed by cerebral magnetic resonance imaging with contrast. Orthostatic headache (developing within 2 h of standing or sitting up) was present in 67 patients (75%) but appeared within 15 min after standing or sitting—as required by point A of the criteria—in only 53 (59%). Forty-four (49%) patients did not satisfy point A, including 22 (24%) with non-orthostatic headache and 14 (16%) with headache developing ≥ 15 min after standing or sitting up; 80 (89%) did not satisfy point D. Only three (3%) patients had headache fully satisfying the IHS criteria. These findings indicate that the current IHS criteria do not capture most patients with SIH-associated headache. Excluding the requirement for response to epidural blood patch (criterion D) and considering headaches appearing within 2 h of sitting or standing up would capture more patients.

scholarly journals Intracranial Hypotension with Severe Neurological Symptoms Resolved by Epidural Blood Patch

2004 ◽  
Vol 31 (4) ◽  
pp. 569-571 ◽  
Author(s):  
Philip W.H. Peng
Keyword(s):  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Short Term Memory ◽  
Spontaneous Intracranial Hypotension ◽  
Memory Loss ◽  
Sensorineural Deafness ◽  
Brain Structures ◽  
Neurological Symptoms ◽  
Orthostatic Headache ◽  
Blood Patch

Background:A patient with a constellation of severe neurological symptoms caused by spontaneous intracranial hypotension, which was successfully managed by epidural blood patch, was described.Case history:A 50-year-old woman presented to the neurological service with a two-month history of orthostatic headache. Associated clinical features included sensorineural deafness, ataxia and short-term memory loss. Magnetic resonance imaging showed downward displacement of brain structures, bilateral subdural collections and the postgadolinium images demonstrated diffuse dural enhancement suggestive of the diagnosis of spontaneous intracranial hypotension.Results:Following a lumbar epidural blood patch, all symptoms improved significantly and her headache resolved.Conclusion:The principal presentation of spontaneous intracranial hypotension is orthostatic headache. The patient described presented a combination of various neurological symptoms, ataxia, memory loss and deafness, which all responded well to epidural blood patch.

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

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.

scholarly journals Epidural Blood Patch for the Treatment of Spontaneous and Iatrogenic Orthostatic Headache

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. E1115-E1122
Author(s):  
Jae Hun Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Study ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Pain Clinic ◽  
Orthostatic Headache ◽  
Group I ◽  
Blood Patch ◽  
Csf Leakage ◽  
Leakage Site

Background: The cerebrospinal fluid (CSF) leakage could be happened spontaneously or related to the procedures such as spinal anesthesia, epidural anesthesia, CSF tapping, intrathecal chemotherapy or other spinal procedures. The leakage of CSF leads to intracranial hypotension of which distinguishing clinical feature is orthostatic headache. The epidural blood patch is a goldstandard treatment for intracranial hypotension-related orthostatic headaches. Objective: We conducted this study to compare the efficacy and number of epidural blood patches for spontaneous and iatrogenic orthostatic headaches. Study Design: Retrospective study. Setting: University hospital inpatient and outpatient referred to our pain clinic. Methods: Sex, weight, height, cause of orthostatic headache, leakage site evaluation test, epidural blood patch injection level, number of administered epidural blood patches, and pain intensity data were collected. We classified patients into two groups according to the cause of orthostatic headache: spontaneous (Group S) and iatrogenic (Group I). Patients with myelograms were also divided into 2 groups: multiple cerebrospinal fluid (CSF) leakages and no multiple leakages. Results: Overall, 133 patients (162 procedures) were managed using epidural blood patches. Groups S and I included 34 and 99 patients, respectively. In Group I, 90.9% of the patients achieved complete recovery following a single procedure, whereas 44.1% of Group S patients required repeated procedures. The average number of administered epidural blood patches was significantly higher in Group S (1.48 ± 0.64) than in Group I (1.11 ± 0.35; P = 0.007). Among 23 patients evaluated via myelography, 12 had multiple CSF leakages. Patients with multiple leakages required a significantly higher number of epidural blood patches, compared to patients without multiple leakages (P = 0.023). Limitations: This retrospective study reveals several limitations including insufficient evaluation of CSF leakage site by myelogram and the retrospective nature of the study itself. Conclusions: Most patients with iatrogenic orthostatic headache required a single epidural blood patch, although most did not undergo a myelogram or similar test. Patients with spontaneous orthostatic headache or multiple CSF leakages were more likely to require a repeated epidural blood patch. Key words: CSF leakage, dural puncture, epidural blood patch, intracranial hypotension, orthostatic headache, spinal headache

scholarly journals Interdisciplinary Diagnosis and Management of Cerebrospinal Fluid Leakage Due to a Meningeal Diverticulum: a Case Report

2020 ◽  
Author(s):  
Christoph Gregor Trumm ◽  
Robert Forbrig
Keyword(s):  
Cerebrospinal Fluid ◽  
False Positive ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leakage ◽  
Ct Guided ◽  
Fluid Leakage ◽  
Blood Patch ◽  
Csf Leakage ◽  
Spinal Epidural

AbstractCerebrospinal fluid leakage through meningeal diverticula represents a diagnostic and therapeutic challenge comparatively rarely encountered in the interdisciplinary management of spontaneous intracranial hypotension (SIH). Several false-positive CSF leakage signs may be observed during the imaging work-up of SIH. A 27-year-old female with orthostatic headache showing marked spinal epidural CSF collections and MRI signs of intracranial hypotension underwent a blind and CT-guided epidural blood patch (EBP) of a pathological T9/10 meningeal diverticulum (MD), detected by dynamic CT myelography (dCTM). After initial good imaging and symptomatic improvement, recurrent symptoms and a large left-sided subdural hematoma required neurosurgical MD ligation, with persisting clinical success. The following aspects of this brief report are remarkable: added value of dCTM to synchronously detect true CSF leakage and false-positive CSF leakage signs, near-complete resolution of spinal epidural CSF collections after CT fluoroscopy–guided EBP, interdisciplinary diagnosis, and definite management of CSF leakage through an anomalous MD.

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