Choi SH, Lee YY, Kim WJ. Epidural blood patch for spontaneous intracranial hypotension with subdural hematoma: A case report and review of literature. World J Clin Cases 2022; 10(1): 388-396 [PMID: 35071543 DOI: 10.12998/wjcc.v10.i1.388]
Corresponding Author of This Article
Won-Joong Kim, MD, PhD, Associate Professor, Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, No. 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, South Korea. ickypoo@naver.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 7, 2022; 10(1): 388-396 Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.388
Epidural blood patch for spontaneous intracranial hypotension with subdural hematoma: A case report and review of literature
Se Hee Choi, Youn Young Lee, Won-Joong Kim
Se Hee Choi, Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
Youn Young Lee, Won-Joong Kim, Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul 07985, South Korea
Author contributions: Kim WJ designed the research study and performed the research; Choi SH and Kim WJ contributed analytic tools; Choi SH, Lee YY, and Kim WJ analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript; Choi SH and Lee YY contributed equally to this study.
Supported byNational Research Foundation of Korea (NRF), the Korean government (MSIT), No. NRF-2019R1G1A1100523.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Won-Joong Kim, MD, PhD, Associate Professor, Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, No. 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, South Korea. ickypoo@naver.com
Received: September 7, 2021 Peer-review started: September 7, 2021 First decision: September 29, 2021 Revised: October 23, 2021 Accepted: November 22, 2021 Article in press: November 22, 2021 Published online: January 7, 2022 Processing time: 114 Days and 3.5 Hours
Abstract
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.
Core Tip: 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. After a repeated targeted cervical epidural blood patch using an epidural catheter under fluoroscopic guidance, the patient’s symptoms had almost disappeared, and a magnetic resonance myelography revealed a decrease in the interval size of the CSF collected. This case highlights the efficacy of the delivery of autologous blood via an epidural catheter inserted into the lower cervical spine as a treatment for SDH in patients with SIH due to CSF leakage at C1/2.
