Intracranial hypotension caused by cervical cerebrospinal fluid leak: treatment with epidural blood patch.
This report describes treatment with cervical epidural blood patch of low cerebrospinal fluid (CSF) pressure headache resulting from spontaneous CSF leak via a tear in a cervical dural cuff. The leak was diagnosed by a dynamic computed tomography (CT)-myelography study followed by gadolinium enhanced magnetic resonance imaging(MRI)-scan. The epidural needle was inserted with the aid of image intensifier and CT-scan to guide the needle to the precise site of the CSF leak. Blood mixed with gadolinium was injected, and subsequent MRI scanning provided the first description of spread of blood after cervical epidural blood patch.


CONCLUSIONS
Low cerebrospinal fluid (CSF) pressure may cause severe posturally-related headache. In the patient, a vertebral disc protrusion in the neck seems to have contributed to a CSF leak. An injection of blood into the epidural space at the precise site of the CSF leak was followed by complete and lasting resolution of the headache.
Cousins
Michael J
MJ
Departments of *Anaesthesia and Pain Management, †Radiology, and ‡Neurosurgery, University of Sydney and Royal North Shore Hospital, St. Leonards, Australia.
Brazier
David
D
Cook
Raymond
R
D017217:Blood Patch, Epidural / Q000379:methods*; D002574:Cervical Vertebrae / Q000473:pathology; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D013353:Subdural Effusion / Q000175:diagnosis / Q000628:therapy*