Epidural blood patch in the treatment of headaches by spontaneous CSF leak

Spontaneous Intracranial Hypotension in Childhood: A Case Report and Review of the Literature

“…4,5,10,11,13,14,21 Where conservative measures fail, autologous epidural blood patch is the treatment of choice. If there is prompt symptom relief, it is both a therapeutic and diagnostic procedure, 2,8,9 as in this case. It is hypothesized that 10-20 mL of blood injected into the subdural space replaces the lost cerebrospinal fluid volume and, over time, tamponades the leak leading to resolution of symptoms.…”

“…Spontaneous intracranial hypotension was first described in 1938 by Schaltenbrand. 12 The spontaneous onset of orthostatic headache in spontaneous intracranial hypotension is believed to result from 1 or more spontaneous spinal cerebrospinal fluid leaks, [1][2][3][4][5][6][7][8]10,11,[13][14][15][16][17][18][19][20][21] as this headache syndrome closely mimics the postural headache that can occur following a lumbar puncture. 13,15,21 The most common sites of these leaks are along the thoracic spine.…”

“…9 A myriad of other symptoms are reported in patients with spontaneous intracranial hypotension. Posterior neck pain or stiffness, [1][2][3][4]8,9,11,13,14,19,21 nausea and vomiting, [1][2][3]8,9,11,[14][15][16]18,19,21 and photophobia 2,7,13,11,19,21 are most commonly described. Interscapular pain, horizontal diplopia, visual blurring, and radicular symptoms in the upper extremities can occur.…”

“…Interscapular pain, horizontal diplopia, visual blurring, and radicular symptoms in the upper extremities can occur. 1,2,4,8,9,[13][14][15]19 Hearing changes including phonophobia, ''echoing,'' ''muffled or distant,'' and tinnitus 1,2,4,8-10, [13][14][15]17,22 are not uncommon and can be associated with vertigo and an altered sense of balance. 2,10,[13][14][15][16][17]21 Rarer manifestations reported include confusion, 1,2,14,16 galactorrhoea and hyperprolectinaemia, 2,14 coma, 14 cranial nerve palsies, 4 parkinsonism, 13,14 chorea, 16 and visual field defects.…”

“…Spontaneous intracranial hypotension has an estimated prevalence of 1 in 50 000, incidence of 5 per 100 000 adults/ year, and most commonly affects middle-aged women. [1][2][3][4][5][6][7][8][9] Spontaneous intracranial hypotension is very uncommon in childhood, with few reports of affected persons aged less than 18 years. 5,[9][10][11] We report a typical case of spontaneous intracranial hypotension in an otherwise healthy 15-year-old girl who presented with a classic orthostatic headache.…”