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Case report
Catheter-guided multilevel epidural blood patches in an adolescent boy
  1. Laurel Walfish1,
  2. Sultan Alobaikan2,
  3. Zubin Lahijanian3,
  4. Christine Saint-Martin4,
  5. Maria delPilar Cortes Nino5 and
  6. Pablo Mauricio Ingelmo6
  1. 1 Department of Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2 Department of Anesthesia, King Abdulaziz Medical City, Riyadh, Al Riyadh, Saudi Arabia
  3. 3 Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec, Canada
  4. 4 Department of Medical Imaging, Montreal Children's Hospital, Montreal, Quebec, Canada
  5. 5 Department of Neuroradiology, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
  6. 6 Edward’s Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, Quebec, Canada
  1. Correspondence to Pablo Mauricio Ingelmo, Edward’s Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, QC H4A 3J1, Canada; pablo.ingelmo{at}mcgill.ca

Abstract

Background There is increasing evidence for the use of multilevel epidural catheter-guided blood patches to treat spontaneous cerebrospinal fluid leaks in adults. Yet, there are scarce data for their use in children. Furthermore, higher level epidural blood patches are uncommon in both adult and pediatric populations.

Case presentation An adolescent boy with multilevel cerebrospinal fluid leaks associated with status migrainosus failed conservative pain management treatment. As he remained severely symptomatic, epidural blood patches were required to mitigate his symptoms. Given his multilevel leaks, a catheter-guided blood patch approach was used to treat multiple cervicothoracic and thoracolumbar leaks. After three separate uneventful blood patch procedures, the patient was free of symptoms. Other than some rebound intracranial hypertension, the patient maintained full neurological capacity without further complications. Following the resolution of treatment, he has not sought help for pain since his last blood patch over a year ago.

Conclusions Multilevel catheter-guided blood patches have the potential to be administered to higher level spinal regions to the pediatric population suffering from multiple spontaneous cerebrospinal fluid leaks.

  • Diagnostic Techniques and Procedures
  • Pain Management
  • Treatment Outcome
  • Acute Pain
  • Pediatrics

https://doi.org/10.1136/rapm-2022-103487

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    Footnotes

    • Twitter @SAlobaikan

    • Contributors LW contributed to the conception, drafting and revision of the manuscript. SA contributed to the clinical care of the patient and revision of the manuscript. ZL contributed to the selection of imaging for the manuscript, drafting and revision of the manuscript. CS-M contributed to the clinical care of the patient and the selection of imaging for the manuscript. MdCN contributed to the clinical care of the patient and revision of the manuscript. PMI contributed to the clinical care of the patient, revision of manuscript and is guarantor.

    • Funding The Montreal Children’s Hospital Foundation and the Louis and Alan Edwards Foundation support the research activities of the Edward’s Family Interdisciplinary Center for Complex Pain.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.