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

Background: Spontaneous intracranial hypotensionis an increasingly relevant cause of headachesas the breadth and depth of its diagnosisand management improves.Objectives: The objective of this case report is todescribe a novel treatment for headaches causedby spontaneous intracranial hypotension withoutlocating the cerebrospinal fluid (CSF) leak and toreview the diagnostic and therapeutic options forspontaneous intracranial hypotension.Study Design: This is a report of a single case.Setting: The setting for this case report is a majoracademic center.Methods: After a review of the treatments andinterventions that our patient had previouslyundergone, we decided to trial epidural bloodpatches for her chronic headaches.Results: Although the exact site of a CSF leakcould not be identified despite exhaustive diagnosticinterventions, cervicothoracic epiduralblood patches provided excellent pain control forour patient’s severe headaches. The patient wascompletely free of headaches for 15 hours andreported well-controlled pain for approximatelya month after her procedure as well as after 5subsequent monthly procedures.Limitations: As this is a report of a single case,more rigorous study in a larger patient populationis needed to provide guidance.Conclusions: This case demonstrates that anontargeted cervicothoracic epidural blood patchcan be a treatment option for patients with spontaneousintracranial hypotension in which clinicalsuspicion is high despite nondiagnostic imaging.Key words: Spontaneous intracranial hypotension,cervicothoracic epidural blood patch,headache