Rebound Intracranial hypertension: A Complication of Epidural Blood Patch as Treatment for Intracranial Hypotension

Abstract

Rebound intracranial hypertension is a known complication of epidural blood patch. An elderly male presented with nausea, vomiting and poor GCS. The MRI brain showed subdural haematoma with sagging of brain matter suggestive of intracranial hypotension secondary to CSF leak resulting from multiple recent sessions of intrathecal chemotherapy. The patient underwent a lumbar epidural blood patch followed by burr hole procedure under general anaesthesia. The patient had a brief period of complete improvement and subsequently reintubated as his GCS deteriorated. The MRI brain shows mild dilatation of ventricles. The diagnostic lumbar puncture showed a high opening pressure confirming the diagnosis of Intracranial Hypertension. The patient completely resolved symptomatically with oral acetazolamide. Conclusion: Anaesthesiologists must be aware about this condition and efforts at adequate monitoring to detect Intra Cranial Hypertension after an Epidural Blood Patch. Keywords: Epidural blood patch; Rebound intracranial hypertension; Intracranial hypotension.