David Walega1, Erin McComb, Joshua Rosenow. 1. Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 251 East Huron Street, Chicago, IL 60611, USA. d-walega@northwestern.edu
Abstract
OBJECTIVES: Spontaneous intracranial hypotension (SIH) is an uncommon cause of headache that can be challenging to treat and can have serious clinical consequences. When symptoms persist despite conservative treatment, an interlaminar epidural blood patch is often performed, but may not be effective. METHODS: Case report and review of the literature. RESULTS AND DISCUSSION: In this clinical report, we describe a case of spontaneous intracranial hypotension caused by a ventral dural tear at the cervicothoracic junction. Our patient suffered from recalcitrant postural headaches despite undergoing conventional interlaminar epidural blood patches. Bilateral transforaminal epidural blood patches were performed in order to deliver blood to the ventral epidural space at the site of the tear identified on magnetic resonance imaging. The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is required to safely perform this procedure.
OBJECTIVES: Spontaneous intracranial hypotension (SIH) is an uncommon cause of headache that can be challenging to treat and can have serious clinical consequences. When symptoms persist despite conservative treatment, an interlaminar epidural blood patch is often performed, but may not be effective. METHODS: Case report and review of the literature. RESULTS AND DISCUSSION: In this clinical report, we describe a case of spontaneous intracranial hypotension caused by a ventral dural tear at the cervicothoracic junction. Our patient suffered from recalcitrant postural headaches despite undergoing conventional interlaminar epidural blood patches. Bilateral transforaminal epidural blood patches were performed in order to deliver blood to the ventral epidural space at the site of the tear identified on magnetic resonance imaging. The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is required to safely perform this procedure.
Authors: Kirk Bowden; Adam Wuollet; Amol Patwardhan; Theodore J Price; John Lawall; Jeffery Annabi; Steven Barker; Emil Annabi Journal: Anesthesiol Res Pract Date: 2011-07-18