scholarly journals Spontaneous C1-2 Cerebrospinal Fluid Leak Treated with a Targeted Cervical Epidural Blood Patch Using a Cervical Epidural Racz Catheter

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E381-E384
Author(s):  
Dr. Yong-Shin Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Cerebrospinal Fluid Leakage ◽  
Blood Patch ◽  
Associated Symptoms ◽  
Occipital Headache

A 39-year-old woman with no history of trauma or meningitis presented to the neurology department of our hospital with an occipital headache, neck pain, nausea, and dizziness that had worsened during the previous month. The headache worsened when sitting or standing and partially regressed when lying down. She was diagnosed with spontaneous intracranial hypotension (SIH) and received conservative management. After failing to respond to conservative management, she underwent an autologous epidural blood patch (EBP) at the T7-8 level. The headache and associated symptoms did not improve after the procedure. Magnetic resonance (MR) myelography suggested a cerebrospinal fluid leakage at the C1-2 level resulting in intracranial hypotension. An 18-gauge Tuohy needle was inserted at the T1-2 interlaminal level using a paramedian approach under fluoroscopic guidance. The cervical epidural Racz catheter was threaded through the Tuohy needle up to the cervical spine and the catheter tip was confirmed to be at the right cervical 1-2 site on an anteroposterior (AP) view. Five mL of autologous blood was injected into the epidural space through the cervical epidural Racz catheter. Her occipital headache and associated symptoms gradually disappeared after the procedure. Seven days later the headache was largely resolved and she was discharged. Follow-up magnetic resonance imaging (MRI) showed the disappearance of abnormal radiological features associated with intracranial hypotension. She currently remains symptom free for 9 months. Delivery of autologous blood patch via a cervical epidural Racz catheter inserted from the upper thoracic spine can be a safe and effective method for patients with SIH due to cerebrospinal fluid (CSF) leakage in the upper cervical spine. Key words: Cerebrospinal fluid leakage, epidural blood patch, intracranial hypotension, myelography, occipital headache

scholarly journals Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level

2017 ◽  
Vol 3 (20;3) ◽  
pp. E465-E468
Author(s):  
Wei-Hung Lien
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Cerebrospinal Fluid Leakage ◽  
Trendelenburg Position ◽  
Fluid Leakage ◽  
Intracranial Hypotension Syndrome ◽  
Blood Patch ◽  
Csf Leakage

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

scholarly journals Intracranial Hypotension Headache Caused by a Massive Cerebrospinal Fluid Leak Successfully Treated with a Targeted C2 Epidural Blood Patch: A Case Report

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 399-404
Author(s):  
Xiaobin Yi
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Spine ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Csf Leak ◽  
Blood Patch ◽  
High Cervical ◽  
Epidural Steroid

Cervical epidural steroid injections, administered either intralaminarly or transforaminally, are common injection therapies used in many interventional pain management practices to treat cervicalgia or cervicobrachial pain secondary to spondylosis or intervertebral disc displacement of the cervical spine. Among the risks associated with these procedures are the risk for inadvertent dural puncture and the development of positional headache from intracranial hypotension. We report the case of a 31-year-old woman with a history of migraine and cervicalgia from cervical spine spondylosis and cervical disc degenerative disease that developed an intractable orthostatic headache accompanied by nausea and vomiting after a therapeutic high cervical intralaminar epidural steroid injection was administered directly to the C1-C2 spinal level. Although the initial magnetic resonance imaging of the brain was unremarkable, a computed tomography myelogram study revealed a massive cerebrospinal fluid (CSF) leak from the cervical spine. Repeated cervical epidural blood patches using a catheter targeted to the high cervical spine (C2) to inject 15 mL of autologous blood was required to totally alleviate her symptoms after she failed conservative therapy. Determining the optimal location or approach to administer an epidural blood patch can be a challenge depending on the location of the CSF leak. Our case demonstrates that targeted cervical epidural blood patch placement using an easily manipulated catheter under fluoroscopic guidance is a safe and effective approach to treat a massive CSF leak in the high cervical spine region caused by prior therapeutic cervical spine epidural steroid injection. Key words: Cervical epidural blood patch, intracranial hypotension, intracranial hypotension headache, spinal headache, orthostatic headache, epidural steroid injection, cerebrospinal fluid leak, post dural headache

Magnetic resonance imaging predicted the therapeutic response of patients with spinal cerebrospinal fluid leakage undergoing targeted epidural blood patch

2021 ◽  
Author(s):  
Hung-Chieh Chen ◽  
Jyh-wen Chai ◽  
Chih-Cheng Wu ◽  
Po-Lin Chen ◽  
Chieh-Lin Teng
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Epidural Blood Patch ◽  
Response To Treatment ◽  
Cerebrospinal Fluid Leakage ◽  
Resonance Imaging ◽  
Blood Patch ◽  
Csf Leakage ◽  
Effective Group

Objectives: Most patients with spinal cerebrospinal fluid (CSF) leakage require an epidural blood patch (EBP); however, the response to treatment is varied. This study aimed to compare the magnetic resonance imaging (MRI) findings at follow-up between EBP effective and non-effective groups and to identify imaging findings that predict EBP treatment failure. Methods: We retrospectively reviewed 48 patients who received EBP treatment for spinal CSF leakage. These patients were stratified into two groups: EBP effective (n = 27) and EBP non-effective (n = 21) using the results of the 3 month MRI as the endpoint. Results: Compared to the EBP non-effective group, the patients in the EBP effective group had a lower spinal CSF leakage number (2.67 vs 12.48; p = 0.001), lower spinal epidural fluid accumulation levels (3.00 vs 7.48; p = 0.004), brain descend (11.11% vs 38.10%; p = 0.027), pituitary hyperemia (18.52% vs 57.14%; p = 0.007), and decreased likelihood of ≥three numbers of spinal CSF leakage (25.93% vs 90.48%; p = 0.001) in the post-EBP MRI. Clinical non-responsiveness (OR: 57.84; 95% CI: 3.47–972.54; p = 0.005) and ≥three numbers of spinal CSF leakage (OR: 15.13; 95% CI: 1.45–159.06; p = 0.023) were associated with EBP failure. Between these variables,≥three numbers of spinal CSF leakage identified using the post-EBP MRI demonstrated greater sensitivity in predicting EBP failure compared to clinical non-responsiveness (90.48% vs 61.9%). Conclusion: The number of spinal CSF leakage identified using the post-EBP MRI with a cut-off value of three is an effective predictor of EBP failure. Advances in knowledge: Compared to clinical responsiveness, the post-EBP MRI provided a more objective approach to predict the effectiveness of EBP treatment in patients with spinal CSF leakage.

CT-Guided Autologous Blood Patch for High-Level Cervical Cerebrospinal Fluid Leakage: Imaging Characteristics and Treatment Safety and Efficiency

2021 ◽  
pp. 1-7
Author(s):  
Xiaofeng He ◽  
Yueyong Xiao ◽  
Xiao Zhang ◽  
Xiaobo Zhang ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Autologous Blood ◽  
Cerebrospinal Fluid Leakage ◽  
Imaging Features ◽  
Ct Guided ◽  
Iodinated Contrast ◽  
Blood Patch ◽  
Csf Leakage ◽  
High Level

<b><i>Introduction:</i></b> Epidural blood patches (EBPs) are rarely performed at the high-level cervical levels. The aim of the study was to investigate the imaging features, safety, and effectiveness of CT-guided percutaneous EBPs for high-level cervical cerebrospinal fluid (CSF) leakage. <b><i>Methods:</i></b> Twenty-five patients with spontaneous high-level (C1–C3) CSF leakage on MRI and CT imaging, including 2 patients with intracranial epidural hematoma caused by CSF, were treated with EBP. Two needles were inserted into the C1–3 bilateral epidural space. The needle location was confirmed by injection of both 3–5mL sterile air and a diluted iodinated contrast agent to delineate its spatial diffusion. The patient’s blood 11.1 ± 3.1 mL was slowly injected to make a patch; the distribution in epidural space was monitored with intermittent CT scanning. <b><i>Results:</i></b> The typical manifestation of CSF leakage was the high signal outside the C1–3 cervical dura on MR T2W fat inhibition images and low density in cervical muscle space on CT images. Twenty patients suffered from headaches and were able to sit and walk 24 h after the operation. Four patients, with partial relief of headache and a small but persistent CSF leakage, were re-treated with EBS. One patient underwent a third operation because of a persistent CSF leakage on MRI. <b><i>Conclusions:</i></b> Imaging of water at the surrounding epidural space of high cervical level is a typical feature of dural rupture on both MRI and CT. CT-guided EBP is safe and efficient for the high-level cervical CSF leakage, especially for cases in which conservative treatments failed.

Post–Dural Puncture Headache

2017 ◽  
Author(s):  
Philip Rubin
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Caffeine Intake ◽  
Recumbent Position ◽  
Post Dural Puncture Headache ◽  
Blood Patch

Post–dural puncture headache (PDPH) is a benign but debilitating condition that may occur as a consequence of any dural puncture, whether intentional (as with spinal anesthesia or lumbar puncture) or inadvertent (as with epidural anesthesia). The headache is characteristically unique, as it is postural in nature—worsened when sitting or standing, and markedly improved in the recumbent position. After the puncture, passage of cerebrospinal fluid (CSF) across the dura mater from a pressurized environment (subarachnoid space) to the epidural space, is the initial culprit behind the headache. Noninvasive conservative measures including hydration, analgesics, and caffeine intake are typically offered as initial treatments, but if those measures fail, the “gold standard” epidural blood patch is commonly offered. This procedure entails injection of autologous blood into the epidural space to both halt continued CSF “loss,” and to increase CSF pressure, both of which aid in headache resolution.

Spontaneous Intracranial Hypotension

2018 ◽  
Author(s):  
Magdalena Anitescu ◽  
David Arnolds
Keyword(s):  
Intracranial Hypotension ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Spontaneous Intracranial Hypotension ◽  
Delay In Diagnosis ◽  
Blood Patch ◽  
Cord Injury ◽  
Detailed Medical History ◽  
Proper Diagnosis

Spontaneous intracranial hypotension is a condition that affects young and middle-aged individuals. Women are more frequently affected than men. It is associated with severe positional headache without previous dural puncture and is often confused with other common headache conditions. Delay in diagnosis of the condition may predispose patients to severe complications. Many radiodiagnostic tools carry important risks to patients, including nerve injury and iatrogenic spinal cord injury. Imaging studies must be correlated with a detailed medical history and a thorough physical examination. Epidural blood patch, the mainstay of treatment, may require multiple attempts with increasing amounts of autologous blood. Increased awareness of spontaneous intracranial hypotension will likely contribute to its proper diagnosis and treatment.

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