Korean J Pain.  2010 Mar;23(1):46-50.

Epidural Blood Patches in a Patient With Multi-level Cerebrospinal Fluid Leakage That Was Induced by Spontaneous Intracranial Hypotension

• Kim SY
• Hong JH

Abstract

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

Keyword

blood patch; epidural; headache; intracranial hypotension; spontaneous

MeSH Terms

Blood Patch, Epidural
Headache
Humans
Intracranial Hypotension
Punctures
Supine Position

Figure

• 

  Fig. 1 Axial enhanced T1-weighted magnetic resonance imaging shows typical change of spontaneous intracranial hypotension with pachymeningeal enhancement (arrow) in a 55-year-old man with multiple spontaneous spinal cerebrospinal fluid leakage.

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  Fig. 2 Radionuclide cisternography shows cerebrospinal fluid leakage at upper cervical vertebral level (thin arrow) and middle thoracic vertebral level (thick arrow).

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