Enrico Ferrante1,2, Michele Trimboli1,3, Giuseppe Petrecca4, Francesco Allegrini4, Mirko Maria Ferrante5, Fabio Rubino6. 1. Neurology Department, AOR San Carlo, Potenza, Italy. 2. Neurology Department, Alto Vicentino Hospital - AULSS 7 Pedemontana, Santorso, Italy. 3. Department of Medical and Surgical Sciences, Institute of Neurology, AOU Mater Domini - Magna Graecia University, Catanzaro, Italy. 4. Anesthesiology and Intensive Care Department, AOR San Carlo, Potenza, Italy. 5. Anesthesiology Department, University of Insubria, Varese, Italy. 6. Palliative Care and Pain Management Department, ASST Valtellina, Sondrio, Italy.
Abstract
BACKGROUND: Spontaneous intracranial hypotension (SIH) is a rare condition resulting from cerebrospinal fluid (CSF) volume depletion, nearly always from spontaneous CSF leaks. CSF pressure in SIH is usually normal; low CSF pressure is found in a substantial minority of patients. SIH is uncommonly described in pregnancy. CASE SERIES: Five women with SIH during pregnancy have been conservatively treated adopting bed rest and overhydration. After prolonged conservative treatment, only 1 patient showed complete symptoms resolution. A rare SIH complication as cerebral venous thrombosis has been reported in 1 case. All 4 remaining patients had lumbar epidural blood patch (EBP) with symptoms disappearance. CONCLUSIONS: EBP might be proposed to SIH patients also during pregnancy and after a brief period (~10 days) of ineffective conservative treatment, because it could allow faster symptoms improvement and complete recovery. Furthermore, EBP would avoid prolonged bed rest with the risk of SIH severe complications.
BACKGROUND:Spontaneous intracranial hypotension (SIH) is a rare condition resulting from cerebrospinal fluid (CSF) volume depletion, nearly always from spontaneous CSF leaks. CSF pressure in SIH is usually normal; low CSF pressure is found in a substantial minority of patients. SIH is uncommonly described in pregnancy. CASE SERIES: Five women with SIH during pregnancy have been conservatively treated adopting bed rest and overhydration. After prolonged conservative treatment, only 1 patient showed complete symptoms resolution. A rare SIH complication as cerebral venous thrombosis has been reported in 1 case. All 4 remaining patients had lumbar epidural blood patch (EBP) with symptoms disappearance. CONCLUSIONS: EBP might be proposed to SIH patients also during pregnancy and after a brief period (~10 days) of ineffective conservative treatment, because it could allow faster symptoms improvement and complete recovery. Furthermore, EBP would avoid prolonged bed rest with the risk of SIH severe complications.