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

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.

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 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.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

1998 ◽  
Vol 88 (2) ◽  
pp. 237-242 ◽  
Author(s):  
John L. D. Atkinson ◽  
Brian G. Weinshenker ◽  
Gary M. Miller ◽  
David G. Piepgras ◽  
Bahram Mokri
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari I Malformation ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Content Type ◽  
Intracranial Hypotension Syndrome ◽  
Csf Leakage ◽  
Chiari I ◽  
Fine Print

Object. Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. Methods. The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. Conclusions. This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

Symptomatic postsurgical cerebrospinal fluid leak treated by aspiration and epidural blood patch under ultrasound guidance in 2 adolescents

2013 ◽  
Vol 11 (1) ◽  
pp. 87-90 ◽  
Author(s):  
Jared S. Fridley ◽  
Andrew Jea ◽  
Chris D. Glover ◽  
Kim P. Nguyen
Keyword(s):  
Cerebrospinal Fluid ◽  
Adolescent Girls ◽  
Epidural Blood Patch ◽  
Cerebrospinal Fluid Leak ◽  
Symptomatic Patient ◽  
Cerebrospinal Fluid Leakage ◽  
Blood Patch ◽  
Csf Leakage ◽  
Unique Method ◽  
Fluid Leak

Cerebrospinal fluid leakage causing a pseudomeningocele is a well-recognized complication after spine surgery. The repair of pseudomeningocele in a symptomatic patient is usually accomplished with direct open surgical repair of the durotomy, prolonged lumbar drainage, and/or placement of an epidural blood patch. The authors highlight a unique method of pseudomeningocele repair by presenting 2 cases of adolescent girls with symptomatic lumbar pseudomeningoceles. In both cases ultrasound was used to guide the aspiration of CSF from each pseudomeningocele and to apply the epidural blood patch. Both patients had complete and immediate resolution of symptoms. The authors found ultrasound to be a useful tool to assess the extent of the CSF leakage, to determine the degree of aspiration of the extradural CSF, and to confirm the injection of the blood into the epidural space and the space created by the pseudomeningocele.

The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage

2018 ◽  
Vol 29 (8) ◽  
pp. 4088-4095 ◽  
Author(s):  
Can Özütemiz ◽  
Yasemin Kocabaş Köksel ◽  
Haitao Huang ◽  
Nathan Rubin ◽  
Jeffrey B. Rykken
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Blood Patch ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Blood Patch
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