Open AccessSpontaneous intracranial hypotension: Two cases including one treated with epidural blood patch
Author(s) -
Poojan Agarwal,
Suresh Me,
Rahulkumar Shah,
Singhal Bs
Publication year - 2009
Publication title -
annals of indian academy of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.427
H-Index - 31
eISSN - 1998-3549
pISSN - 0972-2327
DOI - 10.4103/0972-2327.56318
Subject(s) - medicine , epidural blood patch , spontaneous intracranial hypotension , intracranial hypotension , cerebrospinal fluid , anesthesia , leak , surgery , cerebrospinal fluid leak , orthostatic vital signs , cerebrospinal fluid pressure , encephalopathy , posterior reversible encephalopathy syndrome , intracranial pressure , blood pressure , magnetic resonance imaging , radiology , environmental engineering , engineering
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), low cerebrospinal fluid (CSF) pressure, and diffuse pachymeningeal gadolinium enhancement (DPME). We present here the case studies of two patients. One patient demonstrated a CSF leak in the mid-thoracic region, and recovered completely with conservative treatment. The other patient in whom leak could not be demonstrated, developed dementia, rapidly worsening encephalopathy, and became comatose, necessitating urgent epidural blood patch (EBP) with 25 cc of autologous blood, after which immediate and complete symptomatic relief was obtained. A second EBP was required a few days later and also provided complete and sustained clinical benefit, without subsequent recurrence. Both patients had OH and showed bilateral subdural fluid collections, DPME and "sagging" of brain on MRI. A high index of suspicion, recognizing the orthostatic nature of headache, and typical findings on contrast enhanced MRI should point to the diagnosis of SIH. EBP can be effective treatment in patients unresponsive to conservative measures.