title: Epidural dextran-40 and paramethasone injection for treatment of spontaneous intracranial hypotension.
abstract: OBJECTIVE
  This report describes treatment with epidural dextran-40 and paramethasone injection of postural headache resulting from spontaneous intracranial hypotension in a pregnant patient.
  
  
  METHODS
  A 39-yr-old pregnant woman consulted the pain clinic for the assessment of a debilitating postural headache which was non-responsive to conventional analgesic treatment. Clinical findings and cranial magnetic resonance imaging indicated the diagnosis of spontaneous intracranial hypotension syndrome. Treatment with an epidural blood patch was not undertaken for several reasons. A lumbar epidural injection with dextran-40 and paramethasone led to a significant improvement in the symptoms and allowed a progressive discontinuation of adjuvant treatment with oral steroids, with complete resolution of symptoms.
  
  
  CONCLUSIONS
  We report a case of spontaneous intracranial hypotension in a pregnant patient successfully treated by epidural injection of dextran-40 and paramethasone, with adjuvant oral steroid therapy. Clinical trials are warranted to establish the efficacy of this treatment as an alternative to the epidural blood patch administration.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínic, Barcelona, Spain. ibelmarc@hotmail.com
authors.forename: Ivan
authors.initials: I
authors.lastname: Bel
authors.forename: Luis-Alfonso
authors.initials: LA
authors.lastname: Moreno
authors.forename: Carmen
authors.initials: C
authors.lastname: Gomar
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000627:therapeutic use*; D003911:Dextrans / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D010248:Paramethasone / Q000008:administration & dosage* / Q000627:therapeutic use*; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000627:therapeutic use*; D011247:Pregnancy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003911:Dextrans; D010952:Plasma Substitutes; D010248:Paramethasone