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

Clinical article

Toru HorikoshiDepartment of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan

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Arata WatanabeDepartment of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan

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Mikito UchidaDepartment of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan

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Hiroyuki KinouchiDepartment of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan

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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.
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  • 1

    Atkinson JL, , Weinshenker BG, , Miller GM, , Piepgras DG, & Mokri B: Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg 88:237242, 1998

    • Search Google Scholar
    • Export Citation
  • 2

    Chiapparini L, , Farina L, , D'Incerti L, , Erbetta A, , Pareyson D, & Carriero MR, et al.: Spinal radiological findings in nine patients with spontaneous intracranial hypotension. Neuroradiology 44:143152, 2002

    • Search Google Scholar
    • Export Citation
  • 3

    Diaz JH: Treatment outcomes in spontaneous intracranial hypotension: do epidural blood patches stop the leaks?. Pain Pract 4:295302, 2004

    • Search Google Scholar
    • Export Citation
  • 4

    Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24:Suppl 1 9160, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Hyun SH, , Lee KH, , Lee SJ, , Cho YS, , Lee EJ, & Choi JY, et al.: Potential value of radionuclide cisternography in diagnosis and management planning of spontaneous intracranial hypotension. Clin Neurol Neurosurg 110:657661, 2008

    • Search Google Scholar
    • Export Citation
  • 6

    Lay CM: Low cerebrospinal fluid pressure headache. Curr Treat Options Neurol 4:357363, 2002

  • 7

    Lin WC, , Lirng JF, , Fuh JL, , Wang SJ, , Chang FC, & Ho CF, et al.: MR findings of spontaneous intracranial hypotension. Acta Radiol 43:249255, 2002

    • Search Google Scholar
    • Export Citation
  • 8

    Mokri B, , Hunter SF, , Atkinson JL, & Piepgras DG: Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology 51:786790, 1998

    • Search Google Scholar
    • Export Citation
  • 9

    Mokri B, & Posner JB: Spontaneous intracranial hypotension: the broadening clinical and imaging spectrum of CSF leaks. Neurology 55:17711772, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Nowak DA, , Takano B, & Topka H: Spontaneous cerebrospinal fluid hypovolaemia: a therapeutic dilemma?. Eur J Neurol 13:11281138, 2006

  • 11

    Schievink WI: Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295:22862296, 2006

  • 12

    Schievink WI, , Maya MM, , Louy C, , Moser FG, & Tourje J: Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol 29:853856, 2008

    • Search Google Scholar
    • Export Citation
  • 13

    Spelle L, , Boulin A, , Tainturier C, , Visot A, , Graveleau P, & Pierot L: Neuroimaging features of spontaneous intracranial hypotension. Neuroradiology 43:622627, 2001

    • Search Google Scholar
    • Export Citation
  • 14

    Tsai PH, , Fuh JL, , Lirng JF, & Wang SJ: Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a case-control study. Cephalalgia 27:929934, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    Watanabe A, , Horikoshi T, , Uchida M, , Koizumi H, , Yagishita T, & Kinouchi H: Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome. AJNR Am J Neuroradiol 30:147151, 2009

    • Search Google Scholar
    • Export Citation
  • 16

    Yousry I, , Förderreuther S, , Moriggl B, , Holtmannspötter M, , Naidich TP, & Straube A, et al.: Cervical MR imaging in postural headache: MR signs and pathophysiological implications. AJNR Am J Neuroradiol 22:12391250, 2001

    • Search Google Scholar
    • Export Citation

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