Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatment

Clinical article

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Object

Magnetic resonance imaging may show a fluid collection in the spinal epidural space of patients with spontaneous intracranial hypotension syndrome (SIHS), but the chronological changes remain unclear.

Methods

Brain and spine MR imaging findings were analyzed in 16 patients (9 women and 7 men, mean age 48.6 years) with SIHS before and after treatment.

Results

Diffuse dural enhancement was seen in 15 patients, and the epidural fluid collection in the spinal canal was clear in 15 and equivocal in 1. Symptoms disappeared after bed rest in 1 patient, and an epidural blood patch was performed in 15 patients, resulting in complete resolution of symptoms in 13. After the follow-up period (range 1–20 months, mean 5.0 months), 1 patient had persistent mild headache that gradually worsened in the afternoon, and another patient complained of heaviness of the eyes. Follow-up MR imaging demonstrated disappearance of the dural enhancement in all patients, but a fluid collection in the spinal canal remained in 4. Two of the 4 patients had persistent symptoms, but the other patients exhibited complete resolution of the symptoms.

Conclusions

An epidural blood patch is effective for sealing of CSF leaks, but the resolution of SIHS-related symptoms does not always imply complete eradication of the leakage.

Abbreviations used in this paper: EBP = epidural blood patch; SIHS = spontaneous intracranial hypotension syndrome.

Article Information

Address correspondence to: Toru Horikoshi, M.D., Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan. email: tohruh@yamanashi.ac.jp.

Please include this information when citing this paper: published online November 13, 2009; DOI: 10.3171/2009.10.JNS09806.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 6. Coronal (left) and sagittal (right) MR images showing diffuse dural enhancement and mild enlargement of the pituitary gland but no sagging of the brain.

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    Case 6. Thoracic (A and B) and lumbar (C and D) MR images revealing a fluid collection around the dural sac (arrows) before treatment (A and C) and showing resolution after treatment (B and D).

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    Case 12. Sagittal MR images of showing sagging of the brainstem and cerebellum, thickening of the dura in the craniovertebral junction, and enlarged pituitary gland before treatment (left) and resolution 6 months after treatment (right).

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    Case 12. Fat-saturated T2-weighted MR images of the spine showing fluid collection around the dural sac (arrows) and alongside the nerve roots before treatment (left) and persistent epidural fluid collection dorsal to the dural sac (arrows) 11 months after treatment (right).

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    Case 16. Brain MR images demonstrating narrowing of the CSF spaces, including the ventricles, without diffuse dural enhancement in the convexity on a coronal image (left) and sagging of the brainstem and cerebellum, enlargement of the pituitary gland, and venous plexus ventral to the dural sac (arrow) on the sagittal image (right).

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    Case 16. Thoracic T2-weighted MR image revealing a high-intensity area (arrows) ventral to the midthoracic dural sac (A), enhanced on the CT myelogram 18 months after treatment and thought to be leaked CSF (B), and the persistent fluid collection on the MR image 20 months after treatment (C).

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