title: Epidural blood patch in Trendelenburg position pre-medicated with acetazolamide to treat spontaneous intracranial hypotension.
abstract: BACKGROUND
  Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, diffuse pachymeningeal enhancement on brain magnetic resonance imaging (MRI) and low cerebrospinal fluid (CSF) pressure. Treatment ranges from conservative management, such as bed rest, overhydration and caffeine, to invasive procedures, such as the autologous epidural blood patch (EBP), computed tomography (CT)-guided fibrin glue injection at the site of the leak and open surgical intervention. EBP has emerged as the treatment of choice for SIH when initial conservative measures fail to bring relief.
  
  
  METHODS
  Forty-two patients with SIH were treated with lumbar autologous EBP in Trendelenburg position preceded by pre-medication with acetazolamide.
  
  
  RESULTS
  A complete recovery was obtained in all patients after one (90%), two (5%) or three (5%) EBPs. After EBP, two patients (5%) also performed evacuation of bilateral chronic subdural hematoma with mass effect.
  
  
  CONCLUSIONS
  Spontaneous intracranial hypotension can be effectively cured by lumbar autologous EBP in Trendelenburg position pre-medicated with acetazolamide.
authors.affiliation: Department of Neurosciences, Niguarda Cà Granda Hospital, Milan, Italy. enricoferrante@libero.it
authors.forename: E
authors.initials: E
authors.lastname: Ferrante
authors.forename: I
authors.initials: I
authors.lastname: Arpino
authors.forename: A
authors.initials: A
authors.lastname: Citterio
authors.forename: R
authors.initials: R
authors.lastname: Wetzl
authors.forename: A
authors.initials: A
authors.lastname: Savino
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural / Q000379:methods*; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006801:Humans; D019585:Intracranial Hypotension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods* / Q000592:standards; D011292:Premedication / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D013353:Subdural Effusion / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide