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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Spontaneous intracranial hypotension (SIH) is a rare syndrome with diverse presentations and potential complications, including the formation of subdural hematomas (SDHs). This study aimed to investigate the role of anesthesiologists in diagnosing and treating SIH with associated SDHs.
Methods Twenty-two patients, aged 24 to 65, presenting with orthostatic headache were included in this study. Seventeen of them were diagnosed with SDHs. Diagnostic procedures included contrast-enhanced MRI of the brain and whole spine 3D-T2FS imaging, revealing spinal longitudinal extradural CSF collection (SLEC). Following positive imaging for SIH, prone ultrafast dynamic CT Myelogram was performed by the anesthesiologist to localize the tear. Targeted epidural blood patching using 10-20ml of autologous blood was then administered, with seventeen thoracic, three cervical, and two lumbar patches performed.
Results All patients reported complete resolution of SIH symptoms after the targeted epidural blood patching. Substantial improvement was also observed in MRI scans.
Algorithm is designed to show the recommended pathway for treatment of SIH
Ultrafast dynamic CT myelogram performed by the anaesthesiologist
Targeted epidural blood patch performed by anaesthesiologist
Conclusions This report demonstrates the successful management of SIH and associated SDHs using a multidisciplinary approach involving anesthesiologists. The utilization of advanced imaging techniques, such as contrast-enhanced MRI and prone ultrafast dynamic CT Myelogram, facilitated accurate diagnosis and tear localization. Targeted epidural blood patching with smaller volumes of autologous blood proved to be an effective treatment for these patients. In conclusion, early recognition and intervention using advanced imaging modalities, coupled with targeted epidural blood patching, offer an effective management strategy for SIH and its associated complications. The involvement of anesthesiologists in the diagnosis and treatment of SIH is crucial in providing optimal care for patients.