Annals of Indian Academy of Neurology
  Users Online: 242 Home | About the Journal | InstructionsCurrent Issue | Back IssuesLogin      Print this page Email this page  Small font size Default font size Increase font size
CASE REPORT
Year : 2009  |  Volume : 12  |  Issue : 3  |  Page : 179-182

Spontaneous intracranial hypotension: Two cases including one treated with epidural blood patch


1 Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, India
2 Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India

Correspondence Address:
Pankaj Agarwal
Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.56318

Rights and Permissions

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), low cerebrospinal fluid (CSF) pressure, and diffuse pachymeningeal gadolinium enhancement (DPME). We present here the case studies of two patients. One patient demonstrated a CSF leak in the mid-thoracic region, and recovered completely with conservative treatment. The other patient in whom leak could not be demonstrated, developed dementia, rapidly worsening encephalopathy, and became comatose, necessitating urgent epidural blood patch (EBP) with 25 cc of autologous blood, after which immediate and complete symptomatic relief was obtained. A second EBP was required a few days later and also provided complete and sustained clinical benefit, without subsequent recurrence. Both patients had OH and showed bilateral subdural fluid collections, DPME and "sagging" of brain on MRI. A high index of suspicion, recognizing the orthostatic nature of headache, and typical findings on contrast enhanced MRI should point to the diagnosis of SIH. EBP can be effective treatment in patients unresponsive to conservative measures.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed3198    
    Printed123    
    Emailed1    
    PDF Downloaded148    
    Comments [Add]    
    Cited by others 3    

Recommend this journal