Targeted thoracic epidural blood patch placed under electrical stimulation guidance (Tsui test).
OBJECTIVE
This case report describes the use of electrical epidural stimulation (Tsui test) to confirm accurate placement of a thoracic epidural catheter when administering an epidural blood patch for headache management in a patient suffering from spontaneous intracranial hypotension.


METHODS
A 41-yr-old female presented to the Chronic Pain Clinic with a history of postural headache symptoms worsening in severity over several years. Two previous blood patches performed at T11-12 and T10-11 respectively provided short-term relief only. The presumed diagnosis of a spontaneous dural tear was confirmed by a nuclear flow test to be at T2-T4. The epidural site was accessed at T6 with a Tuohy needle. To accurately place the epidural blood patch at the level of the dural tear, the Arrow catheter with electrode adapter was advanced under nerve stimulation guidance to T4. Ten millilitres of autologous blood injected through the catheter was confirmed on magnetic resonance imaging, one hour postprocedure, to lie between T3 and T9. Sustained headache relief was achieved.


CONCLUSIONS
The use of electrical stimulation guidance may be useful when precise epidural blood patch placement is required.
Department of Anesthesia and Perioperative Medicine, University of Western Ontario Interdisciplinary Pain Program, London, Ontario, Canada. pat.morley-forster@sjhc.london.on.ca
Patricia K
PK
Morley-Forster
Ahmed
A
Abotaiban
Sugantha
S
Ganapathy
Dwight E
DE
Moulin
Andrew
A
Leung
Ban
B
Tsui
D000328:Adult; D017217:Blood Patch, Epidural / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006261:Headache / Q000150:complications / Q000628:therapy; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000628:therapy; D008279:Magnetic Resonance Imaging; D013904:Thoracic Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed