Spontaneous intracranial hypotension
- 29 March 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 76 (13), 1139-1144
- https://doi.org/10.1212/wnl.0b013e318212ab43
Abstract
Objective: The aim of this study was to evaluate the efficacies and compare the outcomes of targeted and blind epidural blood patch (EBP) treatments of spontaneous intracranial hypotension (SIH). Methods: Between January 1999 and December 2009, 56 patients who were diagnosed with SIH received either a targeted or blind EBP. The efficacies of targeted and blind EBPs were evaluated based on degree and duration of symptom relief and on the need for repeat EBP. Results: Fifty-six patients (23 men and 33 women; mean age, 39.6 years; age range, 22–69 years) were included in this study. Thirty-one patients received EBP that targeted CSF leak segments, and 25 received a blind EBP because primary CSF leak sites were not identified (19 patients via a lumbar epidural route, mainly the L 3–4 level, regardless of primary CSF leak site, and 6 patients via upper thoracic epidural spaces, mainly the T4–6 level). In the 31 patients who received a targeted EBP, 27 (87.1%) exhibited clinical improvement after first administration. In contrast, 13 of the 25 patients (52%) who received a blind EBP via a lumbar or upper thoracic epidural route achieved complete recovery. Targeted EBPs were more effective than blind EBPs for the treatment of SIH (p < 0.05). Conclusions: EBPs targeting CSF leaks can be safely placed under fluoroscopic guidance in patients with SIH and are more likely to be effective than blindly placed EBPs.Keywords
This publication has 20 references indexed in Scilit:
- Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatmentJournal of Neurosurgery, 2010
- Epidural blood patch in Trendelenburg position pre‐medicated with acetazolamide to treat spontaneous intracranial hypotensionEuropean Journal of Neurology, 2010
- Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood PatchEuropean Neurology, 2009
- Atypical Spontaneous Intracranial Hypotension (SIH) With Nonorthostatic HeadacheHeadache: The Journal of Head and Face Pain, 2007
- Is It a Rational Choice to Treat with Lumbar Epidural Blood Patch Headache Caused by Spontaneous Cervical CSF Leak?Cephalalgia, 2006
- Spontaneous cerebrospinal fluid leak syndrome: report of 18 casesNeurological Sciences, 2004
- Preface to the Second EditionCephalalgia, 2004
- Intracranial Hypertension After Treatment of Spontaneous Cerebrospinal Fluid LeaksMayo Clinic Proceedings, 2002
- Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotensionJournal of Neurosurgery, 1996
- Epidural blood patch illustrated by CT‐epidurographyActa Anaesthesiologica Scandinavica, 1995