Is It Safe to Perform an Autologous Epidural Blood Patch on Patients with Underlying Spinal Stenosis or Lumbar Disc Disease? Case Report and Literature Review

The most common spinal pathology seen in the obstetric population is lumbar disc herniation. There is currently no literature documenting the safety of performing an epidural blood patch on obstetric patients with underlying spinal pathology. We present a case of a patient with known severe lumbar spinal stenosis with compressive radiculopathy who received a successful epidural blood patch without worsening her underlying neurologic symptoms. Epidural blood patches can be safely performed in this patient population. However, the anesthesiologist should be aware of the risk of potentially worsening preexisting neurological deficits. Thus, we advise caution prior to placing an epidural blood patch on these patients. The risks and benefits of the procedure should be carefully weighed and considered. It is important to have a thorough discussion with the patient regarding the risks of an epidural blood patch prior to performing the procedure.

Epidural Blood Patches Performed with Miethke Sensor Reservoir for Continuous Intracranial Pressure Monitoring

An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteristic postural headaches due to low intracranial pressure. We report a case of a young female with an implanted Miethke Sensor Reservoir, which was used for continuous intracranial pressure (ICP) monitoring during a two-level epidural blood patch. ICP increased only with thoracic injection, suggesting thoracic EBP may have greater efficacy than lumbar EBP in treating SIH and PDPH when the site of CSF leak is unknown.

Intrathecal hematoma and sacral radiculitis following repeat epidural blood patch

Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia.After an inadvertent dural puncture and development of a PDPH,the patient was offered conservative measures for the first 48 hours without improvement.An epidural blood patch(EBP)was placed achieving only moderate relief.Two days later,a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks.Magnetic resonance imaging(MRI)demonstrated the presence of blood in the intrathecal space.This could be the cause of sacral radiculitis,an uncommon complication of an EBP.This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought.As complicated outcomes have followed both conservative and aggressive management,MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.

Epidural blood patch for spontaneous intracranial hypotension with subdural hematoma: A case report and review of literature

BACKGROUND Cerebrospinal fluid(CSF)leakage at C1/2 in spontaneous intracranial hypotension(SIH)is rare.Subdural hematoma(SDH),a serious complication of SIH,may lead to neurological deficits.This report presents a case of SDH after spontaneous C1/2 CSF leakage,which was treated with a targeted epidural blood patch(EBP).CASE SUMMARY A 60-year-old man with no history of trauma was admitted to our hospital with orthostatic headache,nausea,and vomiting.Brain computed tomography imaging revealed bilateral,subacute to chronic SDH.Brain magnetic resonance imaging(MRI)findings were SDH with dural enhancement in the bilateral cerebral convexity and posterior fossa and mild sagging,suggesting SIH.Although the patient underwent burr hole trephination,the patient’s orthostatic headache was aggravated.MR myelography led to a suspicion of CSF leakage at C1/2.Therefore,we performed a targeted cervical EBP using an epidural catheter under fluoroscopic guidance.At 5 d after EBP,a follow-up MR myelography revealed a decrease in the interval size of the CSF collected.Although his symptoms improved,the patient still complained of headaches;therefore,we repeated the targeted cervical EBP 6 d after the initial EBP.Subsequently,his headache had almost disappeared on the 8th day after the repeated EBP.CONCLUSION Targeted EBP is an effective treatment for SDH in patients with SIH due to CSF leakage at C1/2.

Rapid resolution of subdural hematoma after targeted epidural blood patch treatment in patients with spontaneous intracranial hypotension

Background Subdural hematoma （SDH） is a common complication of spontaneous intracranial hypotension （SIH）.To date,the management of SDH caused by SIH remains controversial.In this paper,we reviewed the clinical course of SDH in patients with SIH,and discuss the underlying mechanism and attributing factors for rapid resolution of subdural hematomas after epidural blood patch （EBP） surgery.Methods We retrospectively reviewed a cohort of seventy-eight SIH patients diagnosed and treated with targeted EBP in our neurology center.Patients who received early CT/MRI follow-up after EBP operation were included.Results A series of four cases of SIH complicated with SDHs were evaluated.Early follow-up neuroimages of these patients revealed that SDHs could be partially or totally absorbed just two to four days after targeted epidural blood patch treatment.Conclusion Targeted epidural blood patch can result in rapid hematoma regression and good recovery in some patients with a combination of SDH and SIH.

Management of an intracranial hypotension patient with diplopia as the primary symptom:A case report

BACKGROUND Intracranial hypotension(IH)is a disorder involving cerebrospinal fluid(CSF)hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed,especially in these patients without the prototypical manifestation of an orthostatic headache.At present,the management of IH with both cranial nerve VI palsy and bilateral subdural hematomas(SDHs)is still unclear.CASE SUMMARY A 67-year-old male Chinese patient complained of diplopia on the left side for one and a half mo.Computed tomography revealed bilateral SDHs and a midline shift.However,neurotrophic drugs were not effective,and 3 d after admission,he developed a non-orthostatic headache and neck stiffness.Enhanced magnetic resonance imaging revealed dural enhancement as an additional feature,and IH was suspected.Magnetic resonance myelography was then adopted and showed CSF leakage at multiple sites in the spine,confirming the diagnosis of having IH.The patient fully recovered following multiple targeted epidural blood patch(EBP)procedures.CONCLUSION IH is a rare disease,and to the best of our knowledge,IH with diplopia as its initial and primary symptom has never been reported.In this study,we also elucidated that it could be safe and effective to treat IH patients with associated cranial nerve VI palsy and bilateral SDHs using repeated EBP therapy.

Recurrent Intracranial Hypotension Complicated with Subdural Hematoma—A Case Report and a Case Series Review

Intracranial hypotension has variable clinical manifestations;subdural hematoma is one of the complications of intracranial hypotension with the reported incidence ranging from 16% to 57%. The author would like to share a case of subdural hematoma caused by recurrent intracranial hypotension with different cerebrospinal fluid (CSF) leakage site and to review a case series of intracranial hypotension treated in the author’s hospital (Kaohsiung Veterans General Hospital). A 44-year-old male having the past history of intracranial hypotension was treated in our Neurology division one month previous to this admission, who was sent to our emergency room (ER) due to severe orthostatic headache with nausea and vomiting. Computed tomography (CT) scan of brain at ER showed bilateral subdural hematoma, more on the left side with mass effect. Both surgical removal of the subdural hematoma and epidural blood patch were performed and he had a good outcome. Orthostatic headache is a specific symptom sign of intracranial hypotension. Epidural blood patch is effective to manage intracranial hypotension either the leakage site of CSF is detected or not. In case of non-traumatic subdural hematoma, intracranial hypotension should be kept in mind.

Spontaneous intracranial hypotension complicated with cerebral venous thrombosis and subdural effusion:a case report

Spontaneous intracranial hypotension treatment can be complicated by concomitant cerebral venous thrombosis and subdural hematoma.A 48 years old male,presenting orthostatic headache and neck pain for 1 month displayed sagittal sinus thrombosis and bilateral subdural effusions,as well as extradural fluid collection at T3-T8 level,upon magnetic resonance imaging.Cerebrospinal fluid opening pressure was 50 mmH2O,and a leak was confirmed at C2-C3 level by computed tomography(CT)myelogram.The presence of subdural hematoma precluded anticoagulation treatments.An autologous epidural blood patch at C2-C3 level under CT guidance improved the patient’s condition,remaining free of residual symptoms or recurrence at six-month follow-up.