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Case Reports
. 2024 Jun 24;16(6):e63059.
doi: 10.7759/cureus.63059. eCollection 2024 Jun.

A Low-Volume Epidural Blood Patch for the Treatment of Spontaneous Intracranial Hypotension: A Case Report

Jana Šimonová  1   2 , Stanislava Jaselská  3 , Róbert Šimon  4   5 , Michaela Janková Šimonová  6   7
Affiliations
Case Reports

A Low-Volume Epidural Blood Patch for the Treatment of Spontaneous Intracranial Hypotension: A Case Report

Jana Šimonová et al. Cureus. .

Abstract

Spontaneous intracranial hypotension (SIH) is a rare neurological syndrome. We report the case of a 47-year-old woman with acute, severe orthostatic headache after surgery, chemotherapy, and radiotherapy for breast cancer. The brain and spine magnetic resonance imaging showed signs of intracranial hypotension. We describe the results of a non-targeted epidural blood patch with 10 mL of the patient's blood administered after unsuccessful conservative treatment. After the procedure, the patient reported gradual headache relief. This effect persisted over one year. The case shows that a single non-targeted low-volume epidural blood patch can be an effective treatment option for a patient with SIH when conservative treatment fails.

Keywords: cerebrospinal fluid leak; conservative treatment; epidural blood patch; orthostatic headache; spontaneous intracranial hypotension.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Brain MRI on February 1, 2023.
A: Sagittal T2-weighted images. The white arrow shows subdural collection up to 5 mm in the parietal area, and the red arrow shows the distended convex appearance of the transverse sinus (signs of venous distension). B: Axial T1 images with contrast. The red arrow shows diffuse, smooth dural thickening and enhancement. C: Sagittal T2-weighted images. The red arrow shows slight inhomogeneity and pituitary gland enlargement, and the white arrow shows cerebellar tonsil herniation into the foramen magnum.
Figure 2
Figure 2. C spine MRI on February 2, 2023.
A: Axial T2-weighted images. The white arrow shows the T1 right foraminal cerebrospinal fluid leak. B: Sagittal T2-weighted images. The white arrows show the spinal longitudinal extradural fluid collection type 1b.
Figure 3
Figure 3. Brain MRI on March 5, 2023.
Sagittal T2-weighted images. The white arrow shows a regression of the subdural fluid collection in the parietal area to 2.5 mm.
Figure 4
Figure 4. C spine MRI on March 5, 2023.
Sagittal T2-weighted images. The white arrows show the regression of spinal longitudinal extradural fluid collection.
Figure 5
Figure 5. Brain MRI on September 4, 2023.
A: Sagittal T1 with contrast images showing total regression of spontaneous intracranial hypotension signs. B: Axial T1 with contrast images without any pachymeningeal enhancement.
Figure 6
Figure 6. C spine MRI on September 4, 2023.
Sagittal T2-weighted images showing total spinal longitudinal extradural fluid collection resorption.
See this image and copyright information in PMC

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