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B413 Treating spontaneous intracranial hypotension with an anesthetic modality: the role of the epidural blood patch
  1. Z Masourou1,
  2. N Papagiannakis2,
  3. G Mantzikopoulos3,
  4. DD Mitsikostas2 and
  5. K Theodoraki1
  1. 1Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
  2. 2Aiginiteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
  3. 3Department of Radiology, KAT General Hospital of Attica, Kifissia, Greece


Background and Aims Spontaneous intracranial hypotension (SIH) is a rare syndrome characterized by heterogeneity of presentation and prognosis, which can occasionally result in serious complications. This case series aims to emphasize that SIH remains a diagnostic and therapeutic challenge; if conservative treatment fails, an epidural blood patch (EBP) is a viable treatment option. Although the exact aetiology of SIH is not known, it is believed to be due to cerebrospinal fluid (CBF) leak or a low CBF pressure

Methods Three patients with age ranging between 38–53 years old who presented with complaints not only of an orthostatic headache, but with a variety of symptoms of SIH, including the formation of two subdural hematomas in one of them, were included in this series. These patients did not respond to conservative management and subsequently were referred to the Anaesthesia Department for an EBP.

Results All three patients were subjected to an EBP with an 18-gauge epidural needle placed into the middle epidural compartment at the T12–L3 level. A total of between 30–43 ml of autologous blood was collected from the patients’ left basilic vein and was injected into the epidural space under strict aseptic conditions. All patients reported complete resolution of symptoms following the EBPs, while magnetic resonance imaging improved substantially.

Conclusions This report describes three cases of SIH with CSF leak originating from the cervical, the thoracic and the lumbar level. The EBP restored CSF volume and relieved the patients‘ persistent symptoms. EBP is a well-accepted and beneficial treatment modality for SIH when conventional measures fail.

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