scholarly journals Early Epidural Blood Patch to Treat Intracranial Hypotension after Iatrogenic Cerebrospinal Fluid Leakage from Lumbar Tubular Microdiscectomy

Cureus ◽  
2018 ◽  
Author(s):  
Lukas Faltings ◽  
Kay O Kulason ◽  
Victor Du ◽  
Julia R Schneider ◽  
Shamik Chakraborty ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Blood Patch

scholarly journals Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level

2017 ◽  
Vol 3 (20;3) ◽  
pp. E465-E468
Author(s):  
Wei-Hung Lien
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Cerebrospinal Fluid Leakage ◽  
Trendelenburg Position ◽  
Fluid Leakage ◽  
Intracranial Hypotension Syndrome ◽  
Blood Patch ◽  
Csf Leakage

Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic resonance imaging demonstrated diffuse dural enhancement on the postcontrast study, sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2 level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented to people, place, and time. We chose thoracic EBP as first line treatment in consideration of the risk of cervical EBP such as spinal cord and nerve root compression or puncture, chemical meningitis. Also we put our patient in Trendelenburg position to make blood travel towards the site of the leak. Untreated IHS may delay the course of resolution and affect the patient’s consciousness. Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2. Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position

The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage

2018 ◽  
Vol 29 (8) ◽  
pp. 4088-4095 ◽  
Author(s):  
Can Özütemiz ◽  
Yasemin Kocabaş Köksel ◽  
Haitao Huang ◽  
Nathan Rubin ◽  
Jeffrey B. Rykken
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Blood Patch ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Blood Patch

scholarly journals Spontaneous C1-2 Cerebrospinal Fluid Leak Treated with a Targeted Cervical Epidural Blood Patch Using a Cervical Epidural Racz Catheter

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E381-E384
Author(s):  
Dr. Yong-Shin Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Cerebrospinal Fluid Leakage ◽  
Blood Patch ◽  
Associated Symptoms ◽  
Occipital Headache

A 39-year-old woman with no history of trauma or meningitis presented to the neurology department of our hospital with an occipital headache, neck pain, nausea, and dizziness that had worsened during the previous month. The headache worsened when sitting or standing and partially regressed when lying down. She was diagnosed with spontaneous intracranial hypotension (SIH) and received conservative management. After failing to respond to conservative management, she underwent an autologous epidural blood patch (EBP) at the T7-8 level. The headache and associated symptoms did not improve after the procedure. Magnetic resonance (MR) myelography suggested a cerebrospinal fluid leakage at the C1-2 level resulting in intracranial hypotension. An 18-gauge Tuohy needle was inserted at the T1-2 interlaminal level using a paramedian approach under fluoroscopic guidance. The cervical epidural Racz catheter was threaded through the Tuohy needle up to the cervical spine and the catheter tip was confirmed to be at the right cervical 1-2 site on an anteroposterior (AP) view. Five mL of autologous blood was injected into the epidural space through the cervical epidural Racz catheter. Her occipital headache and associated symptoms gradually disappeared after the procedure. Seven days later the headache was largely resolved and she was discharged. Follow-up magnetic resonance imaging (MRI) showed the disappearance of abnormal radiological features associated with intracranial hypotension. She currently remains symptom free for 9 months. Delivery of autologous blood patch via a cervical epidural Racz catheter inserted from the upper thoracic spine can be a safe and effective method for patients with SIH due to cerebrospinal fluid (CSF) leakage in the upper cervical spine. Key words: Cerebrospinal fluid leakage, epidural blood patch, intracranial hypotension, myelography, occipital headache

scholarly journals Interdisciplinary Diagnosis and Management of Cerebrospinal Fluid Leakage Due to a Meningeal Diverticulum: a Case Report

2020 ◽  
Author(s):  
Christoph Gregor Trumm ◽  
Robert Forbrig
Keyword(s):  
Cerebrospinal Fluid ◽  
False Positive ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leakage ◽  
Ct Guided ◽  
Fluid Leakage ◽  
Blood Patch ◽  
Csf Leakage ◽  
Spinal Epidural

AbstractCerebrospinal fluid leakage through meningeal diverticula represents a diagnostic and therapeutic challenge comparatively rarely encountered in the interdisciplinary management of spontaneous intracranial hypotension (SIH). Several false-positive CSF leakage signs may be observed during the imaging work-up of SIH. A 27-year-old female with orthostatic headache showing marked spinal epidural CSF collections and MRI signs of intracranial hypotension underwent a blind and CT-guided epidural blood patch (EBP) of a pathological T9/10 meningeal diverticulum (MD), detected by dynamic CT myelography (dCTM). After initial good imaging and symptomatic improvement, recurrent symptoms and a large left-sided subdural hematoma required neurosurgical MD ligation, with persisting clinical success. The following aspects of this brief report are remarkable: added value of dCTM to synchronously detect true CSF leakage and false-positive CSF leakage signs, near-complete resolution of spinal epidural CSF collections after CT fluoroscopy–guided EBP, interdisciplinary diagnosis, and definite management of CSF leakage through an anomalous MD.

scholarly journals Spontaneous Cervical (C1–C2) Cerebrospinal Fluid Leakage Repaired with Computed Tomography-Guided Cervical Epidural Blood Patch

2010 ◽  
Vol 40 (3) ◽  
pp. e9-e12 ◽  
Author(s):  
Massimo Allegri ◽  
Francesco Lombardi ◽  
Paola Scagnelli ◽  
Mario Corona ◽  
Cristina E. Minella ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Epidural Blood Patch ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Blood Patch

Cervical Foraminal Epidural Blood Patch for the Targeted Treatment of Refractory Cerebrospinal Fluid Leakage From a Dural Sleeve

2017 ◽  
pp. 1
Author(s):  
Nuj Tontisirin ◽  
Pannawit Benjhawaleemas ◽  
Sasikaan Nimmaanrat ◽  
Pornchai Sathirapanya ◽  
Teeranan Laohawiriyakamol ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Blood Patch ◽  
Targeted Treatment ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Blood Patch

scholarly journals Intracranial Hypotension Due to Cerebrospinal Fluid Leakage Detected by Radioisotope Cisternography.

2000 ◽  
Vol 40 (8) ◽  
pp. 404-407 ◽  
Author(s):  
Toshiyuki SUGINO ◽  
Yasuhiro MATSUSAKA ◽  
Yutaka MITSUHASHI ◽  
Keiji MURATA ◽  
Masakazu SAKAGUCHI
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage
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