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Lack of Increase in Intracranial Pressure After Epidural Blood Patch in Spinal Cerebrospinal Fluid Leak

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Abstract

Background and Importance

Epidural blood patch (EBP) is one therapeutic measure for patients suffering from spontaneous intracranial hypotension (SIH) or post-lumbar puncture headaches. It has been proposed that an EBP may directly seal a spinal cerebrospinal fluid (CSF) fistula or result in an increase in intracranial pressure (ICP) by a shift of CSF from the spinal to the intracranial compartment. To the best of our knowledge this is the first case of a patient with SIH and neurological deterioration in whom ICP was measured before, during, and after spinal EBP.

Clinical Presentation

This 52-year old previously healthy man presented with holocephal headaches. MRI showed a left hemispheric subdural fluid collection causing a significant mass effect. Myelography revealed a CSF leak with epidural contrast at the left side of the L-2 level. To seal the CSF leak, we performed an EBP procedure targeted at left L-2 level and recorded ICP. After applying the epidural blood patch (15 cc) the patient improved rapidly, ICP however remained unchanged before, during, and after the procedure. One day post-treatment, he had a GCS score increase from 12 to 15 and no headache or neurological deficits.

Conclusion

A shift of CSF from the spinal to the cranial compartment with a subsequent rise in ICP might not be a beneficial therapeutic mechanism of spinal epidural blood patching.

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Acknowledgments

The final draft of the manuscript was proofread by Susan Wieting, Bern University Hospital, Publications Office, Bern Switzerland.

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Correspondence to Jürgen Beck.

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Fichtner, J., Fung, C., Z`Graggen, W. et al. Lack of Increase in Intracranial Pressure After Epidural Blood Patch in Spinal Cerebrospinal Fluid Leak. Neurocrit Care 16, 444–449 (2012). https://doi.org/10.1007/s12028-012-9702-4

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  • DOI: https://doi.org/10.1007/s12028-012-9702-4

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