Cervicothoracic Epidural Blood Patch Provides Pain Relief after Failed Lumbar Epidural Blood Patch: A Case Report

Background: Spontaneous intracranial hypotension is an increasingly relevant cause of headaches as the breadth and depth of its diagnosis and management improves. Objectives: The objective of this case report is to describe a novel treatment for headaches caused by spontaneous intracranial hypotension without locating the cerebrospinal fluid (CSF) leak and to review the diagnostic and therapeutic options for spontaneous intracranial hypotension. Study Design: This is a report of a single case. Setting: The setting for this case report is a major academic center. Methods: After a review of the treatments and interventions that our patient had previously undergone, we decided to trial epidural blood patches for her chronic headaches. Results: Although the exact site of a CSF leak could not be identified despite exhaustive diagnostic interventions, cervicothoracic epidural blood patches provided excellent pain control for our patient’s severe headaches. The patient was completely free of headaches for 15 hours and reported well-controlled pain for approximately a month after her procedure as well as after 5 subsequent monthly procedures. Limitations: As this is a report of a single case, more rigorous study in a larger patient population is needed to provide guidance. Conclusions: This case demonstrates that a nontargeted cervicothoracic epidural blood patch can be a treatment option for patients with spontaneous intracranial hypotension in which clinical suspicion is high despite nondiagnostic imaging. Key words: Spontaneous intracranial hypotension, cervicothoracic epidural blood patch, headache