TY - JOUR
T1 - Epidural blood patch for spontaneous intracranial hypotension with subdural hematoma
T2 - A case report and review of literature
AU - Choi, Se Hee
AU - Lee, Youn Young
AU - Kim, Won Joong
N1 - Funding Information:
Supported by National Research Foundation of Korea (NRF), the Korean government (MSIT), No. NRF-2019R1G1A1100523.
Publisher Copyright:
© 2022. The Author(s). Published by Baishideng Publishing Group Inc. All Rights Reserved.
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - Case report
KW - Cerebrospinal fluid
KW - Chronic subdural hematoma
KW - Epidural blood patch
KW - Myelography
KW - Spontaneous intracranial hypotension
UR - http://www.scopus.com/inward/record.url?scp=85122588758&partnerID=8YFLogxK
U2 - 10.12998/wjcc.v10.i1.388
DO - 10.12998/wjcc.v10.i1.388
M3 - Article
AN - SCOPUS:85122588758
SN - 2307-8960
VL - 10
SP - 388
EP - 396
JO - World Journal of Clinical Cases
JF - World Journal of Clinical Cases
IS - 1
ER -