Early pain relief from orthostatic headache and hearing changes in spontaneous intracranial hypotension after epidural blood patch

Ferrante, Enrico; Olgiati, Elena; Sangalli, Valentina; Rubino, Fabio

doi:10.1007/s13760-016-0617-2

Cited by 15 publications

(12 citation statements)

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“…The headache location was most commonly diffuse, occipital, or frontal. 15, [26][27][28][29] Table 1 shows all the other signs and symptoms reported and their pooled estimates of proportions. Downloaded From: https://jamanetwork.com/ on 01/10/2021…”

Section: Clinical Presentationmentioning

confidence: 99%

Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome

et al. 2021

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IMPORTANCE Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The best management options for patients with SIH are still uncertain.OBJECTIVE To provide an objective summary of the available evidence on the clinical presentation, investigations findings, and treatment outcomes for SIH.DATA SOURCES Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline-compliant systematic review and meta-analysis of the literature on SIH. Three databases were searched from inception to April 30, 2020: PubMed/MEDLINE, Embase, and Cochrane. The following search terms were used in each database: spontaneous intracranial hypotension, low CSF syndrome, low CSF pressure syndrome, low CSF volume syndrome, intracranial hypotension, low CSF pressure, low CSF volume, CSF hypovolemia, CSF hypovolaemia, spontaneous spinal CSF leak, spinal CSF leak, and CSF leak syndrome. STUDY SELECTION Original studies in English language reporting 10 or more patients with SIH were selected by consensus.DATA EXTRACTION AND SYNTHESIS Data on clinical presentation, investigations findings, and treatment outcomes were collected and summarized by multiple observers. Random-effect meta-analyses were used to calculate pooled estimates of means and proportions. MAIN OUTCOMES AND MEASURESThe predetermined main outcomes were the pooled estimate proportions of symptoms of SIH, imaging findings (brain and spinal imaging), and treatment outcomes (conservative, epidural blood patches, and surgical). RESULTSOf 6878 articles, 144 met the selection criteria and reported on average 53 patients with SIH each (range, 10-568 patients). The most common symptoms were orthostatic headache (92% [95% CI, 87%-96%]), nausea (54% [95% CI, 46%-62%]), and neck pain/stiffness (43% [95% CI, 32%-53%]). Brain magnetic resonance imaging was the most sensitive investigation, with diffuse pachymeningeal enhancement identified in 73% (95% CI, 67%-80%) of patients. Brain magnetic resonance imaging findings were normal in 19% (95% CI, 13%-24%) of patients. Spinal neuroimaging identified extradural cerebrospinal fluid in 48% to 76% of patients. Digital subtraction myelography and magnetic resonance myelography with intrathecal gadolinium had high sensitivity in identifying the exact leak site. Lumbar puncture opening pressures were low, normal (60-200 mm H 2 O), and high in 67% (95% CI, 54%-80%), 32% (95% CI, 20%-44%), and 3% (95% CI, 1%-6%), respectively. Conservative treatment was effective in 28% (95% CI, 18%-37%) of patients and a single epidural blood patch was successful in 64% (95% CI, 56%-72%). Large epidural blood patches (>20 mL) had better success rates than small epidural blood patches (77% [95% CI, 63%-91%] and 66% [95% CI, 55%-77%], respectively).CONCLUSIONS AND RELEVANCE Spontaneous intracranial hypotension should not be excluded on the basis of a nonorthostatic headache, normal neuroimaging findings, or normal lumbar puncture opening pressure. Despite the heterogeneous nature of the studies...

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Section: Clinical Presentationmentioning

confidence: 99%

Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome

et al. 2021

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“…The current study presents data on various aspects of upright posture intolerance in patients with headaches due to intracranial hypotension before and after epidural blood injection using a semiquantitative assessment. Previous studies have reported the effectiveness of epidural blood injection on orthostatic headaches and hearing difficulties in patients with intracranial hypotension (Ferrante, Olgiati, Sangalli, & Rubino, ; So et al., ; Wu et al., ). Our study provides additional information regarding another important aspect of intracranial hypotension syndrome, which is upright posture intolerance.…”

Section: Discussionmentioning

confidence: 99%

Effect of epidural blood injection on upright posture intolerance in patients with headaches due to intracranial hypotension: A prospective study

et al. 2018

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BackgroundWe performed a prospective study to quantify changes in various aspects of upright posture intolerance in patients with intracranial hypotension.MethodsSix patients were provided a standard questionnaire before, immediately after epidural blood patch injection and at follow‐up visit within 1 month after epidural blood injection inquiring: (a) How long can they stand straight without any support? (b) Do they feel any sense of sickness when they sit or lie down after standing? (c) How long do they have to wait before they are comfortable standing again after they have stood straight? (d) How effectively and fast can they get up from sitting or lying position to stand straight? and (e) Rate their activities in upright posture without support on a standard vertical visual analogue scale between 100 (can do everything) and 0 (cannot do anything).ResultsAll patients responded that they could not stand straight for ≥30 min (four responding <5 min) on pretreatment evaluation. All patients reported improvement in this measure immediately postprocedure with two reporting ≥30 min. At follow‐up, three patients reported further improvement and one patient reported worsening in this measure. The magnitude of improvement ranged from 10 to 80 points increase immediately postprocedure in their ability to perform activities, while they are standing without any support on visual analogue scale. At follow‐up, four patient reported additional improvement in their ability to perform activities, while they are standing without any support (ranged from 10 to 20 points increase compared with immediately postprocedure rating).ConclusionsWe present semiquantitative data on various aspects of upright posture intolerance in patients with intracranial hypotension before and after epidural blood injection.

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“…In general, patches have positive outcomes and an overall efficacy of approximately 90% [ 21 ]. However, several complications such as hearing changes [ 22 ], vision loss [ 23 ], and transient bladder and fecal incontinence [ 24 ] have been reported with the procedures. Some trials have suggested the greater efficacy of radiologic-targeted EBPs, compared to blind EBPs, for treating spontaneous intracranial hypotension [ 21 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model

Kuo¹,

Kao²,

Tsou

et al. 2017

PLoS ONE

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BackgroundNo reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. In this study, we produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We also aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process.MethodsTwo-dimensional and three-dimensional optical coherence tomography images were obtained using a swept source optical coherence tomography (SSOCT) system. Four laboratory pigs were intubated and ventilated after the induction of general anesthesia. An 18-gauge Tuohy needle was used as a tunnel for the optical coherence tomography probe to the epidural space. Two-dimensional and three-dimensional reconstruction optical coherence tomography images of the epidural space were acquired in four stages.ResultsIn stage 1, real-time two-dimensional and reconstructed three-dimensional optical coherence tomography of the lumbar and thoracic epidural space were successfully acquired. In stage 2, the epidural catheter in the epidural space was successfully traced in the 3D optical coherence tomography images. In stage 3, water injection and lumbar puncture were successfully monitored in all study animals. In stage 4, 10 mL of fresh blood was injected into the epidural space and two-dimensional and three-dimensional optical coherence tomography images were successfully acquired.ConclusionsThese animal experiments suggest the potential capability of using an optical coherence tomography-based imaging needle in the directed two-dimensional and three-dimensional visualization of the epidural space. More investigations involving humans are required before optical coherence tomography can be recommended for routine use. However, three-dimensional optical coherence tomography may provide a novel, minimally invasive, and safe way to observe the spinal epidural space, epidural catheter, lumbar puncture hole, and blood patch.

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Early pain relief from orthostatic headache and hearing changes in spontaneous intracranial hypotension after epidural blood patch

Cited by 15 publications

References 8 publications

Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome

Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome

Effect of epidural blood injection on upright posture intolerance in patients with headaches due to intracranial hypotension: A prospective study

In vivo images of the epidural space with two- and three-dimensional optical coherence tomography in a porcine model

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