title: Successful treatment of spontaneous intracranial hypotension due to prominent cervical cerebrospinal fluid leak with cervical epidural blood patch.
abstract: OBJECTIVE
  To report a case of successful treatment of a patient with spontaneous intracranial hypotension correlated with MRI finding of cerebrospinal fluid (CSF) leak with extradural collection at the upper cervical spinal level.
  
  
  METHODS
  Case report.
  
  
  METHODS
  An academic tertiary pain management center.
  
  
  METHODS
  Fluoroscopically guided placement of an 18-gauge epidural needle into epidural space at the C7-T1 level was performed; an epidural catheter (Braun Perifix 20G) was advanced to C2 level (first patch) and C3 level (second patch). An epidurogram with Omnipaque injections confirmed contrast in the posterior and lateral epidural space. Autologous venous blood was then administered through the catheter.
  
  
  RESULTS
  This patient received two lumbar epidural blood patches without lasting relief. Given the radiographic evidence of prominent CSF leak with extradural fluid collection at C1-2 level, the patient was then treated with a cervical epidural blood patch, which provided headache pain relief lasting 6 months. A second cervical epidural blood patch was performed, and the patient has been headache-free for nearly one year to date.
  
  
  CONCLUSIONS
  Based on the successful treatment of this patient's spontaneous intracranial hypotension, we advocate that patients undergo epidural blood patches to target the site of any CSF leak identified by imaging studies to improve the efficacy of this intervention. This case demonstrates that cervical epidural blood patch, despite its inherent risks, may be more effective than lumbar epidural blood patch in treatment of cervical CSF leak.
authors.affiliation: Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Wang
authors.affiliation: Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.
authors.forename: Dajie
authors.initials: D
authors.lastname: Wang
mesh_terms: D017217:Blood Patch, Epidural / Q000379:methods*; D065634:Cerebrospinal Fluid Leak / Q000628:therapy*; D002574:Cervical Vertebrae; D006801:Humans; D019585:Intracranial Hypotension / Q000628:therapy*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged
keywords: Epidural Blood Patch; Intracranial Hypotension; Low Pressure Headache; Magnetic Resonance Imaging