Date: 05 Jan 2010

Rare complications associated with epidural blood patches

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To the Editor,

I read with great interest the recently published case report of Drs. Mehta and Tarshis describing their experience with repeated large-volume epidural blood patch for the treatment of spontaneous intracranial hypotension.1 While the authors observed a successful outcome using this approach and identified potential complications of epidural blood patch, they failed to mention a little-known complication of high volume epidural injection, i.e., visual loss.2 Visual loss associated with epidurals is rarely reported in the literature; a recent review in 2005 found 12 cases.3 In these cases, the volume of injectate varied from 20 to 120 mL with resulting retinal hemorrhage. Seventy-nine percent of the patients fully recovered. The pathophysiology is thought to be secondary to the sudden increase of epidural pressure during epidural injection, which is transmitted up to the optic nerve sheath rupturing the retinal blood vessels. These reports highlight the importance of slowly