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CC BY 4.0 · J Neuroanaesth Crit Care
DOI: 10.1055/s-0044-1790253
Case Report

Epidural Blood Patch in Spontaneous Intracranial Hypotension and Role of Optic Nerve Sheath Diameter: A Case Report

Dimple Shah
1   Neuroanaesthesiology and Neurocritical Care, Institute of Neurosciences, Kolkata, West Bengal, India
,
Sanghita Layek
1   Neuroanaesthesiology and Neurocritical Care, Institute of Neurosciences, Kolkata, West Bengal, India
,
Bibhukalyani Das
1   Neuroanaesthesiology and Neurocritical Care, Institute of Neurosciences, Kolkata, West Bengal, India
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Abstract

Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF) and it is characterized by an orthostatic headache without a history of trauma or dural puncture. Patients may present with headache, there may be low CSF pressure, or imaging evidence of CSF leak. Epidural blood patching (EBP) has been considered as the mainstay of therapy for SIH. We report a case of SIH with bilateral subdural hematoma in a 63-year-old female patient who presented with sudden-onset headache for 4 days without any history of loss of consciousness, vomiting, or seizures. Lumbar EBP was given and it resulted in improved clinical features, imaging findings, and increase in optic nerve sheath diameter (ONSD) when compared with ONSD before EBP administration. EBP produces a tamponade effect and its efficacy results from sealing the dural defect by the injected blood, thus stopping the CSF leak.

Keywords

epidural blood patch - optic nerve sheath diameter - spontaneous intracranial hypotension


Publication History

Article published online:
04 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295 (19) 2286-2296
    CrossrefPubMedSearch in Google Scholar
  • 2 Ferrante E, Rubino GF, Passarani S, Arpino I. Spontaneous intracranial hypotension. J Neurosurg 2010; 113 (02) 397-398 , author reply 398–399
    CrossrefPubMedSearch in Google Scholar
  • 3 Shima K, Ishihara S, Tomura S. Pathophysiology and diagnosis of spontaneous intracranial hypotension. Acta Neurochir Suppl (Wien) 2008; 102: 153-156
    CrossrefPubMedSearch in Google Scholar
  • 4 Schievink WI. Spontaneous spinal cerebrospinal fluid leaks: a review. Neurosurg Focus 2000; 9 (01) e8-e8
    CrossrefPubMedSearch in Google Scholar
  • 5 Rozec B, Guillon B, Desal H, Blanloeil Y. Value of epidural blood-patches for the treatment of spontaneous intracranial hypotension [in French]. Ann Fr Anesth Réanim 2004; 23 (12) 1144-1148
    PubMedSearch in Google Scholar
  • 6 Schievink WI, Maya MM, Moser FG, Tourje J. Spectrum of subdural fluid collections in spontaneous intracranial hypotension. J Neurosurg 2005; 103 (04) 608-613
    CrossrefPubMedSearch in Google Scholar
  • 7 Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 2003; 10 (04) 376-381
    CrossrefPubMedSearch in Google Scholar
  • 8 Dubost C, Le Gouez A, Zetlaoui PJ, Benhamou D, Mercier FJ, Geeraerts T. Increase in optic nerve sheath diameter induced by epidural blood patch: a preliminary report. Br J Anaesth 2011; 107 (04) 627-630
    CrossrefPubMedSearch in Google Scholar
  • 9 Rettenmaier LA, Park BJ, Holland MT. et al. Value of targeted epidural blood patch and management of subdural hematoma in spontaneous intracranial hypotension: case report and review of the literature. World Neurosurg 2017; 97: 27-38
    CrossrefPubMedSearch in Google Scholar
  • 10 Cho KI, Moon HS, Jeon HJ, Park K, Kong DS. Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch. Neurology 2011; 76 (13) 1139-1144
    CrossrefPubMedSearch in Google Scholar