Abstract
Background and Importance
Epidural blood patch (EBP) is one therapeutic measure for patients suffering from spontaneous intracranial hypotension (SIH) or post-lumbar puncture headaches. It has been proposed that an EBP may directly seal a spinal cerebrospinal fluid (CSF) fistula or result in an increase in intracranial pressure (ICP) by a shift of CSF from the spinal to the intracranial compartment. To the best of our knowledge this is the first case of a patient with SIH and neurological deterioration in whom ICP was measured before, during, and after spinal EBP.
Clinical Presentation
This 52-year old previously healthy man presented with holocephal headaches. MRI showed a left hemispheric subdural fluid collection causing a significant mass effect. Myelography revealed a CSF leak with epidural contrast at the left side of the L-2 level. To seal the CSF leak, we performed an EBP procedure targeted at left L-2 level and recorded ICP. After applying the epidural blood patch (15 cc) the patient improved rapidly, ICP however remained unchanged before, during, and after the procedure. One day post-treatment, he had a GCS score increase from 12 to 15 and no headache or neurological deficits.
- Content Type Journal Article
- Category Practical Pearl
- Pages 1-6
- DOI 10.1007/s12028-012-9702-4
- Authors
- Jens Fichtner, Department of Neurosurgery, Bern University Hospital, Publications Office, 3010 Bern, Switzerland
- Christian Fung, Department of Neurosurgery, Bern University Hospital, Publications Office, 3010 Bern, Switzerland
- Werner Z`Graggen, Department of Neurosurgery, Bern University Hospital, Publications Office, 3010 Bern, Switzerland
- Andreas Raabe, Department of Neurosurgery, Bern University Hospital, Publications Office, 3010 Bern, Switzerland
- Jürgen Beck, Department of Neurosurgery, Bern University Hospital, Publications Office, 3010 Bern, Switzerland
- Journal Neurocritical Care
- Online ISSN 1556-0961
- Print ISSN 1541-6933
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