Continuous Epidural Saline Infusion for the Treatment of Low CSF Pressure Headache

Gibson, Beth E.; Wedel, Denise J.; Faust, Ronald J.; Petersen, Ronald C.

doi:10.1097/00000542-198805000-00020

Cited by 79 publications

(40 citation statements)

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“…This was the case for patient 2. When the headache persists and is incapacitating, more aggressive treatment may be necessary, including both epidural saline infusion and autologous epidural blood patches [1,3,5,11,24,25,26]. We used the blood-patch method, probably the most efficacious, in three patients, injecting 15±20 ml of their own blood into the epidural space.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging features of spontaneous intracranial hypotension

Spelle¹,

Boulin

Tainturier

et al. 2001

Neuroradiology

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We reviewed the cranial MRI and radionuclide cisternograms of four adults with postural headache indicating spontaneous intracranial hypotension (SIH). All four underwent clinical and radiological follow-up. MRI showed diffuse, thin meningeal enhancement; bilateral subdural fluid collections; and morphological abnormalities secondary to "sagging" of the brain. Radionuclide cisternography revealed direct or indirect signs of leakage of cerebrospinal fluid (CSF) along the spinal axis, and the symptoms resolved after the leak treated by epidural injection of blood at a level indicated by the cisternogram. The diffuse meningeal enhancement decreased but persisted on follow-up MRI, although the patients were asymptomatic. All morphologic abnormalities resolved during 3-5 months follow-up.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging features of spontaneous intracranial hypotension

Spelle¹,

Boulin

Tainturier

et al. 2001

Neuroradiology

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“…Refractory or chronic relapsing cases may be treated by epidural injection of either saline or autologous blood, or by intrathecal saline infusion. 6,7,19,23,24) If such conservative measures fail and a single lesion causing CSF leakage can be identified, then early closure by surgical intervention may be required. [23][24][25] K. Yoshimoto et al…”

Section: Discussionmentioning

confidence: 99%

Multi-level Disruption of the Spinal Nerve Root Sleeves in Spontaneous Spinal Cerebrospinal Fluid Leakage. Two Case Reports.

Yoshimoto

Takeshita

Inoue

et al. 2001

Neurol. Med. Chir.(Tokyo)

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A 37-year-old male and an 18-year-old male presented with spontaneous spinal cerebrospinal fluid (CSF) leakage from multiple nerve root sleeves. Both patients suffered abrupt onset of intense headache followed by nausea, dizziness, and one patient with and one without positional headache. Radioisotope spinal cisternography of both patients revealed that the CSF leaks were not localized in a special zone but distributed to multiple spinal nerve root sleeves. Magnetic resonance (MR) myelography suggested that the spinal CSF column was fully expanded to the root sleeves. The extraspinal nerve bundles demonstrated numerous high intensity spots. Both patients were treated conservatively, and their symptoms resolved within one month. Repeat radioisotope cisternography and MR myelography confirmed the spine was normal after recovery. We suggest that spreading disruption of the arachnoid membrane occurs at the nerve root sleeves due to CSF overflow into the spinal canal.

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“…15,42,54 Such therapy can be considered (with limited expectations) in some of the patients in whom repeated blood patch procedures have failed, especially if the site of the leak has not been found, which excludes a surgical approach.…”

Section: Treatment Optionsmentioning

confidence: 99%

Cerebrospinal fluid volume depletion and its emerging clinical/imaging syndromes

Mokri

2000

FOC

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Cerebrospinal fluid (CSF) volume depletion, due to CSF leakage or CSF shunt overdrainage, is typically indicated when patients present with orthostatic headaches, with or without several other symptoms: neck or interscapular pain, nausea, emesis, diplopia, changes in hearing, visual blurring, facial numbness or weakness, and radicular upper-limb symptoms. Cerebrospinal fluid pressures typically are quite low and head magnetic resonance images typically reveal diffuse pachy-meningeal gadolinium enhancement, with or without evidence of sagging of the brain and less frequently with subdural fluid collections, enlarged cerebral venous sinuses or pituitary gland or decreased ventricular size. Magnetic resonance imaging has revolutionized detection of spontaneous CSF leaks, leading to identification of far more cases and recognition of several clinical/imaging forms of presentation of the disorder. These forms, which are different from the “typical” presentation, include a group with consistently normal CSF pressures (normal pressure), another group without abnormal meningeal enhancement (normal meninges), and a group without headache (acephalic). Each of these forms can be seen in a setting of documented and ongoing CSF volume depletion. Awareness of CSF volume depletion is increasing, and its clinical and imaging spectrum is broadening.

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Continuous Epidural Saline Infusion for the Treatment of Low CSF Pressure Headache

Cited by 79 publications

References 0 publications

Neuroimaging features of spontaneous intracranial hypotension

Neuroimaging features of spontaneous intracranial hypotension

Multi-level Disruption of the Spinal Nerve Root Sleeves in Spontaneous Spinal Cerebrospinal Fluid Leakage. Two Case Reports.

Cerebrospinal fluid volume depletion and its emerging clinical/imaging syndromes

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