title: Bilateral cervicothoracic transforaminal blood patches for persistent headache from spontaneous intracranial hypotension: a case report and review.
abstract: OBJECTIVE
  Spontaneous intracranial hypotension (SIH) is an uncommon cause of headache that can be challenging to treat and can have serious clinical consequences. When symptoms persist despite conservative treatment, an interlaminar epidural blood patch is often performed, but may not be effective.
  
  
  METHODS
  Case report and review of the literature.
  
  
  CONCLUSIONS
  In this clinical report, we describe a case of spontaneous intracranial hypotension caused by a ventral dural tear at the cervicothoracic junction. Our patient suffered from recalcitrant postural headaches despite undergoing conventional interlaminar epidural blood patches. Bilateral transforaminal epidural blood patches were performed in order to deliver blood to the ventral epidural space at the site of the tear identified on magnetic resonance imaging. The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is required to safely perform this procedure.
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 251 East Huron Street, Chicago, IL 60611, USA. d-walega@northwestern.edu
authors.forename: David
authors.initials: D
authors.lastname: Walega
authors.forename: Erin
authors.initials: E
authors.lastname: McComb
authors.forename: Joshua
authors.initials: J
authors.lastname: Rosenow
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural / Q000379:methods*; D005260:Female; D006261:Headache / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D019585:Intracranial Hypotension / Q000134:cerebrospinal fluid / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods; D012445:Sacrococcygeal Region