Treatment of spontaneous intracranial hypotension with multiple leakage sites of cerebrospinal fluid : A case report

Ko, Hee Chang; Jung, Jong Kwon; Moon, Hyun Seok; Song, Jang Ho; Eum, Son Hyoung; Cha, Young Deog

Case Report

General Article

Anesthesia and Pain Medicine 2008;3(4):330-334.
Published online October 30, 2008.

Treatment of spontaneous intracranial hypotension with multiple leakage sites of cerebrospinal fluid : A case report

Hee Chang Ko, Jong Kwon Jung, Hyun Seok Moon, Jang Ho Song, Son Hyoung Eum, Young Deog Cha

¹Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea. ydchaan@daum.net
²Hyun Seok Moon's Pain Clinic, Incheon, Korea.

Abstract

Spontaneous intracranial hypotension (SIH) is an uncommon disease that's caused by cerebrospinal fluid (CSF) leakage and this disease is considered to be an important cause of persistent headache. It is characterized by a postural headache in patients who are without any history of dural puncture or trauma. Conservative management, including bed rest analgesics and intravenous fluid administration, are the first-line treatment of SIH, and an autologous epidural blood patch (EBP) is generally indicated for those who fail the conservative management. We report here on a case of SIH with confirmed CSF leakage at the cervical, thoracic and lumbar levels, and this was successfully managed with a single autologous EBP at the lumbar level. We believe that an EBP at the leakage site with the highest pressure level should be considered as a primary treatment for SIH with multiple sites of leakage.

Key Words: cerebrospinal fluid, epidural blood patch, headache, spontaneous intracranial hypotension