Treatment of Intracranial Hypertension-Related Headache Causing Low Cerebrospinal Fluid Pressure Requiring Epidural Blood Patch

Abstract

BACKGROUND: Patients can have a lumbar puncture for numerous reasons, including therapeutic cerebrospinal fluid (CSF) drainage in patients with idiopathic intracranial hypertension (IIH). Aggressive CSF drainage to alleviate the IIH headache can inadvertently cause a low-pressure postdural puncture headache (PDPH). CASE REPORT: We report the novel case of a patient with an IIH headache, which was treated with CSF drainage resulting in a PDPH and subsequent return of the IIH headache. Physical examination findings of papilledema and the nonpositional character after the epidural blood patch (EBP), and improvement of symptoms with topiramate and dexamethasone, show that IIH was the likely cause of her post-EBP headaches. CONCLUSIONS: The best-case scenario is to prevent severe cases of PDPH in this patient population. The authors recommend targeting intracranial pressure (ICP) after the treatment of IIH to the high-normal range to prevent PDPH. If IIH headache symptoms arise after EBP, conservative measures to reduce ICP can be utilized, such as acetazolamide, topiramate, and dexamethasone. KEY WORDS: Epidural blood patch, idiopathic intracranial hypertension, lumbar puncture, postdural puncture headache