Abstract
Spontaneous intracranial hypotension (SIH) is an uncommon disorder caused by cerebrospinal fluid (CSF) leaks in the spine. Treatment is directed at sealing the site of leak, which is often difficult to localize. We present a case of near fatal SIH that was treated with cervical epidural blood patch (EBP) and burr hole drainage of the hematoma. A 41-year old male presented with severe headache after drinking alcohol over several weeks. Brain magnetic resonance imaging (MRI) showed features typical of SIH. But, further imaging with MR myelography and radionuclide cisternography failed to identify a precise site of leak. Despite lumbar EBP, the patient’s orthostatic headache recurred and developed acute subdural hematoma(SDH) to require burr hole drainage for hematoma evacuation. After surgery, the patient’s mental state improved, and the amount of SDH decreased, but he still complained of severe orthostatic headache. We performed EBP at cervico-thoracic junction level. The headache was rapidly relieved and the SDH was completely absorbed. In this case, we aim to remind clinicians that cervical EBP should be considered management for SIH as an alternative to the repeated lumbar blood patch.
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