Epidural blood patch for spontaneous intracranial hypotension with subdural hematoma: A case report and review of literature
- 주제(키워드) Cerebrospinal fluid , Chronic subdural hematoma , Epidural blood patch , Myelography , Spontaneous intracranial hypotension , Case report
- 주제(기타) Medicine, General & Internal
- 설명문(일반) [Choi, Se Hee] Ewha Womans Univ, Anesthesiol & Pain Med, Mokdong Hosp, Seoul 07985, South Korea; [Lee, Youn Young; Kim, Won-Joong] Ewha Womans Univ, Sch Med, Anesthesiol & Pain Med, 1071 Anyangcheon Ro, Seoul 07985, South Korea
- 등재 SCIE, SCOPUS
- OA유형 gold, Green Published
- 발행기관 BAISHIDENG PUBLISHING GROUP INC
- 발행년도 2022
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000190854
- 본문언어 영어
- Published As https://doi.org/10.12998/wjcc.v10.i1.388
- PubMed https://pubmed.ncbi.nlm.nih.gov/35071543
초록/요약
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 8(th) 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.
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