Epidural Saline Infusion Research Articles

Continuous Epidural Saline Infusion for the Treatment of Spontaneous Intracranial Hypotension.

Spontaneous intracranial hypotension (SIH) is an increasingly recognized cause of orthostatic headache, but treatment strategies remain controversial. The epidural blood patch is a well-known and widely used treatment in patients with conservative treatment-resistant SIH, but symptoms may not improve even after multiple epidural blood patches, and resistant patients suffer from a lack of appropriate treatment options. Therefore, this study assessed the safety and efficacy of continuous epidural saline infusion (CESI) for SIH treatment. CESI was performed in 11 consecutive patients affected by conservative treatment-resistant SIH. Patient characteristics were obtained by reviewing medical records retrospectively. Headache intensity was assessed using the numerical rating scale (NRS), and changes in NRS before and after treatment were recorded. The average treatment period for CESI was 21.3±9.6days, and the average follow-up period was 35.0±30.2months. CESI was without major complications or mortality, and no infections occurred, even without prophylactic antibiotics. The median NRS score before treatment was 10 points, improving to 5 points 1day after infusion (P < 0.05), 2 points 1week after infusion (P < 0.05), and 0 points at 3months after infusion and the final follow-up. No patients have since experienced recurrence of orthostatic headaches. CESI appears to be a safe and well-tolerated procedure for SIH. Further experience may demonstrate this technique to be a viable treatment option for SIH.

The Effect of Speed of Normal Saline Injection on Optic Nerve Sheath Diameter in Thoracic Epidural Anesthesia

Background: Intracranial pressure (ICP) is affected after epidural saline solution or local anesthetic injection. Both ICP and epidural pressures have been shown to reach peak pressure just after epidural injection and begin decline thereafter. Measuring the optic nerve sheath diameter (ONSD) through ultrasonography is one of the noninvasive methods used for ICP assessment. Objectives: The purpose of this study was to investigate the effect of the speed of epidural saline injection on the ONSD under awake conditions. Study Design: Prospective randomized trial. Setting: An interventional pain management practice in South Korea. Methods: This study included 40 patients receiving thoracic epidural catheterization for pain management after upper abdominal or thoracic surgery. Following successful epidural space confirmation, patients were randomized to receive epidural saline infusion with a speed of either 1 mL/second (slow speed, A group) or 3 mL/second (rapid speed, B group), respectively. For the measurement of ONSD, transorbital sonography was performed and ONSD was measured at 3 mm posterior to the optic nerve head. Results: The A and B groups showed significant increases in ONSD according to time. Post hoc analysis of this result revealed that ONSD at T10 and T30 were significantly increased from baseline values (T0) (*P &lt; 0.05 vs. T0; +P &lt; 0.001 vs. T0). The mean values at any of the time points and degree of changes (T1-T0, T10-T0, and T30-T0) in ONSD between groups A and B did not show any significance. Limitations: We could not confirm the time of normalization of ONSD after the end of epidural injection of normal saline. Conclusions: Thoracic epidural injection of 10 mL of normal saline solution resulted in a significant increase of ONSD compared to baseline, however, the speed of injection did not affect the increase of ONSD. Key words: Epidural, saline, optic nerve, diameter

Effect of continuous epidural saline infusion to the cerebrospinal fluid hypovolemia occurring in after-stretching exercise

Effect of continuous epidural saline infusion to the cerebrospinal fluid hypovolemia occurring in after-stretching exercise

Traitement de l’hypotension spontanée du liquide cérébrospinal par perfusion épidurale de sérum salé isotonique

Introduction Spontaneous intracranial hypotension (SIH) is an uncommon cause of secondary headache due to a cerebrospinal fluid (CSF) hypotension. Lumbar epidural blood-patch (LEBP) is the most effective treatment and can be repeated in case of relapse. There is no standard therapeutic strategy for patients free of dural tears who fail to respond to several consecutive blood-patches. We report two cases of SIH successfully treated by an epidural saline infusion after two consecutive LEBP. Case reports A 35-year-old woman was admitted to hospital for severe orthostatic headache. The diagnosis of SIH was retained. Two LEBP were performed but with no clinical benefit. Headache disappeared totally after an epidural saline infusion. A second woman, aged 75 years, was admitted for chronic orthostatic headaches. The CSF pressure was low. Search for a dural tear was negative. After two unsuccessful LEBPs, the patient was treated with an epidural saline infusion. Her headache resolved completely and definitely. Discussion It is common procedure to search for a dural tear when patients fail to respond to several consecutive LEPB. Surgical repair is however exceptional. An epidural saline infusion might be an efficient therapeutic alternative despite the small number of cases reported in the literature.

Two Cases of Spontaneous Intracranial Hypotension with Subdural Hematoma

Spontaneous intracranial hypotension (SIH) is an uncommon disease which present as a spontaneously occurring postural headache. Diagnosis is supported by a low CSF pressure by lumbar puncture, diffuse dural enhancement on gadolinium-enhanced brain MRI, or by a CSF leakage site on a radioisotope cistemography or by computed tomographic myelography. Usually SIH treatment is conservative but often requires caffeine, steroids, continuous epidural saline infusion and an epidural blood patch.The most important complication of SIH is bilateral subdural hematoma (SDH), because it may require urgent neurosurgical intervention. We experienced two-cases of SIH with SDH treated with an epidural blood patch, but subdural hematoma increased after radioisotope cistemography , so burr hole drainage was perfonned with another epidural blood patch.

Spontaneous intracranial hypotension treated with a cervical epidural blood patch

Spontaneous intracranial hypotension treated with a cervical epidural blood patch

Orthostatic tinnitus: an otological presentation of spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is a syndrome characterized by orthostatic headache, low cerebrospinal fluid (CSF) pressure without apparent causes for CSF loss, and diffuse pachymeningeal gadolinium enhancement on cranial MRI. Hearing is affected in some patients with SIH. A case of SIH with orthostatic tinnitus is reported. A 51-year-old woman developed a severe headache that was almost completely relieved on recumbency. Cranial MRI with gadolinium infusion showed diffuse enhancement of the dura mater. Radionuclide cisternography demonstrated CSF leaks at the upper and lower thoracic levels. Epidural blood patches at these leak sites alleviated the orthostatic headache, however, orthostatic tinnitus and muffled hearing persisted. Initial audiometry was unremarkable; repeat audiometry performed 6 weeks later demonstrated low-frequency hearing loss in the right ear. Continuous epidural saline infusion for 3 consecutive days was performed; auditory symptoms disappeared 4 weeks thereafter. This case illustrates that orthostatic tinnitus represent intracranial hypotension even in the absence of orthostatic headache. MRI with gadolinium infusion should be carried out in the evaluation of patients with orthostatic tinnitus.

Terson’s syndrome following epidural saline injection

Terson’s syndrome refers to vitreous hemorrhage after intracranial hemorrhage, often from rupture of an aneurysm. The source of vitreous blood has never been established conclusively. Blood may track along the subarachnoid space of the optic nerve sheath and enter the vitreous cavity through the optic nervehead. Alternatively, the sudden spike in intracranial pressure may burst retinal vessels. We describe a rare case of vitreous hemorrhage after epidural saline injection that offers a clue to the origin of the vitreous blood in Terson’s syndrome. A 39-year-old telephone dispatcher developed chronic low back pain that could not be relieved by physical therapy. She was treated with a series of lumbar epidural steroid injections over a 6-month period. An inadvertent dural puncture occurred, giving rise to a persistent postdural puncture headache. After bedrest, analgesics, and oral hydration failed to bring relief, she was treated with two lumbar epidural blood patches, which were also ineffective. She was then offered epidural saline infusion. The procedure was performed by …

Pneumocephalus following the treatment of a postdural puncture headache with an epidural saline infusion

We report a case of pneumocephalus following the attempted treatment of a postdural puncture headache by a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomiting prompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. The epidural space was located easily with the loss-of-resistance technique using 3 ml of air. A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter. We suggest that air passed from the negative-pressure epidural space through the dural puncture created by the diagnostic spinal tap, producing a pneumocephalus.

Successful Treatment of Dural Puncture Headache With Epidural Saline Infusion After Failure of Epidural Blood Patch

A case is presented of a 30-year-old female with a 4-month history of post-lumbar puncture headache (PLPHA) resulting from an accidental dural puncture during an attempted epidural anesthetic for cesarean section. Epidural blood patches were attempted at 4 days and 3 months post-lumbar puncture, but were unsuccessful. At 4 months post-lumbar puncture, a 24-h epidural saline infusion relieved the PLPHA for 48 h, but the headache returned. Finally, a second epidural saline infusion was done, followed by an epidural blood patch, which permanently cured the PLPHA. Follow-up to 4 months showed no return of the PLPHA. The rationale for epidural blood and saline patches is discussed.