title: Lack of increase in intracranial pressure after epidural blood patch in spinal cerebrospinal fluid leak.
abstract: BACKGROUND
  Epidural blood patch (EBP) is one therapeutic measure for patients suffering from spontaneous intracranial hypotension (SIH) or post-lumbar puncture headaches. It has been proposed that an EBP may directly seal a spinal cerebrospinal fluid (CSF) fistula or result in an increase in intracranial pressure (ICP) by a shift of CSF from the spinal to the intracranial compartment. To the best of our knowledge this is the first case of a patient with SIH and neurological deterioration in whom ICP was measured before, during, and after spinal EBP.
  
  
  METHODS
  This 52-year old previously healthy man presented with holocephal headaches. MRI showed a left hemispheric subdural fluid collection causing a significant mass effect. Myelography revealed a CSF leak with epidural contrast at the left side of the L-2 level. To seal the CSF leak, we performed an EBP procedure targeted at left L-2 level and recorded ICP. After applying the epidural blood patch (15 cc) the patient improved rapidly, ICP however remained unchanged before, during, and after the procedure. One day post-treatment, he had a GCS score increase from 12 to 15 and no headache or neurological deficits.
  
  
  CONCLUSIONS
  A shift of CSF from the spinal to the cranial compartment with a subsequent rise in ICP might not be a beneficial therapeutic mechanism of spinal epidural blood patching.
authors.affiliation: Department of Neurosurgery, Bern University Hospital, Publications Office, 3010 Bern, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Fichtner
authors.forename: Christian
authors.initials: C
authors.lastname: Fung
authors.forename: Werner
authors.initials: W
authors.lastname: Z'Graggen
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
mesh_terms: D017217:Blood Patch, Epidural / Q000009:adverse effects*; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care / Q000379:methods; D006801:Humans; D019585:Intracranial Hypotension / Q000503:physiopathology / Q000628:therapy*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016896:Treatment Outcome