Arachnoiditis, a complication of epidural blood patch for the treatment of low‐pressure headache: A case report and systematic review

Villani, Linda A.; Digre, Kathleen B.; Cortez, Melissa; Bokat, Christina; Rassner, Ulrich; Ozudogru, Seniha

doi:10.1111/head.14076

Cited by 15 publications

(13 citation statements)

References 40 publications

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“…We identified 39 sources with 186 patients who developed severe neurologic complications and LMF after NAA "misadventure." Blood patches used for dural leaks accidentally injected into the SAS can also cause LMF [937]. The incidence of LMF from post-obstetrical NAA was 0.2% (182/73303).…”

Section: Iatrogenic Causes or Associationsmentioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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Background & importance This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare “iatrogenic chronic meningitis” causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. Methods The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. Results Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. Discussion & conclusion DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.

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Section: Iatrogenic Causes or Associationsmentioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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show abstract

“…The main clinical manifestation of rebound intracranial hypertension is headache, nausea, vomiting, and blurred vision [ 13 ], which makes it difficult to distinguish from the clinical manifestation of SIH. Recently reported fatal complications such as acute vision loss [ 14 ] and arachnoiditis [ 15 ] secondary to an EBP, raise the necessity for the further alternative treatment options.…”

Section: Discussionmentioning

confidence: 99%

Greater occipital nerve blockade using ultrasound guidance for the headache of spontaneous intracranial hypotension - A case report -

Hong

Lee

2022

Anesth Pain Med

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BackgroundSpontaneous intracranial hypotension occurs due to cerebrospinal fluid leakage from the spinal column, and orthostatic headache is the most common clinical presentation. Recent studies showed that bilateral greater occipital nerve blockade demonstrated clinical efficacy in relieving post-dural puncture headache after caesarean section. CaseA 40-year-old male who presented severe orthostatic headache was consulted to our pain clinic from neurology department. He initially felt a dull nature pain over the whole occipital area which then spread over the frontal and parietal areas. His headache was combined with nausea and vomiting. An epidural blood patch was delayed until final cisternography, and bilateral greater occipital nerve blockade using ultrasound guidance was performed instead. After the blockade, the previously existing headache around the occipital and parietal areas disappeared completely, but mild headache persisted around the frontal area.ConclusionsGreater occipital nerve blockade could be a good therapeutic alternative to improve headache resulting from spontaneous intracranial hypotension.

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“…Women in the C-EBP group received statistically significantly higher doses of blood than women in the F-EBP group: C-EBP 29 ml IQR [23-36] vs. F-EBP group 16 mL IQR [12][13][14][15][16][17][18], p < .001.…”

Section: Primaryoutcomementioning

confidence: 99%

Flouroscopic versus conventional epidural blood patch in obstetrics: A retrospective cohort study

Orbach‐Zinger

Leibzon

Gonen

et al. 2022

Acta Anaesthesiol Scand

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Background: Epidural blood patch is a common effective treatment for postdural puncture headache after accidental dural puncture during labor and may be done in conventional or fluoroscopy-guided methods. The aim of this study was to compare intensity of headache at the time of discharge from the hospital and to compare blood volumes injected in conventional epidural blood patches versus fluoroscopic-guided blood patches and evaluate the side effects of both method of treatment.Methods: Between the years 2010 and 2020, 84 patients who were diagnosed with postdural puncture headache received either a conventional epidural blood patch or a fluoroscopic-guided blood patch. Blood volumes were compared and evaluation of side effects was made based on data collected during and after the procedure.Results: Eighty-four patients were included in this study. Fifty-two women in the conventional epidural blood patch group and 32 in the fluoroscopic-guided blood patch group. Women in the conventional epidural blood patch group received statistically significantly higher doses of blood than women in the fluoroscopic-guided blood patch group: conventional method 29 ml IQR [23][24][25][26][27][28][29][30][31][32][33][34][35][36] versus fluoroscopic method 16 ml, IQR [12][13][14][15][16][17][18], p < .001 with no difference in headache pain intensity at hospital release. There was no difference between groups in hospital length of stay, or persistent PDPH. There was also no difference chronic headache or backache between the two groups.Conclusions: Women who received fluoroscopic epidural blood patch required a much lower volume of blood injected while there was no difference between groups in headache pain intensity at discharge.

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Arachnoiditis, a complication of epidural blood patch for the treatment of low‐pressure headache: A case report and systematic review

Cited by 15 publications

References 40 publications

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Greater occipital nerve blockade using ultrasound guidance for the headache of spontaneous intracranial hypotension - A case report -

Flouroscopic versus conventional epidural blood patch in obstetrics: A retrospective cohort study

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