Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Griauzde, Julius; Gemmete, Joseph J.; Chaudhary, Neeraj; Wilson, Thomas J.; Pandey, Aditya S.

doi:10.3174/ajnr.a3945

Cited by 26 publications

(20 citation statements)

References 18 publications

(24 reference statements)

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“…All 5 patients with a CSF leak underwent a large-volume epidural blood patch procedure through a single-catheter access site to multiple sites in the epidural space, as described previously. 11 Four patients exhibited improvement of their symptoms with this procedure. One of these patients pursued experimental treatment at another institution despite the improving symptoms.…”

Section: Resultsmentioning

confidence: 99%

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Intrathecal preservative-free normal saline challenge magnetic resonance myelography for the identification of cerebrospinal fluid leaks in spontaneous intracranial hypotension

Griauzde¹,

Gemmete²,

Pandey³

et al. 2015

JNS

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S pontaneouS intracranial hypotension (SIH) classically presents as a positional headache that is worsened by orthostasis. Additional symptoms may include dizziness, tinnitus, vomiting, altered mental status, and behavioral changes. 10,11,16 Findings on routine brain CT and MRI scans help to confirm a clinical suspicion of SIH. 5These diagnostic imaging findings include pachymeningeal enhancement, a sagging brain, small ventricular size, and engorged venous sinuses. 9 The combination of these clinical and imaging findings makes diagnosing an SIH often straightforward.6 However, locating the causative CSF leak often remains a challenge. Although new therapeutic techniques have improved the rates of successful treatments of SIH patients with an occult leakage site, identifying the exact location of the CSF leak is preferred before deciding on therapy.11,15 The purpose of this case series was to present our experience with intrathecal preservative-free normal saline challenge followed by contrast-enhanced MR myelography (CEMRM), which we used to provoke and detect a CSF leak in patients with SIH.abbreviatioNs CEMRM = contrast-enhanced MR myelography; CTM = CT myelography; Gd = gadolinium; SIH = spontaneous intracranial hypotension. submitted September 5, 2014. accepted December 11, 2014. iNclude wheN citiNg Published online July 3, 2015; DOI: 10.3171/2014.12.JNS142057. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The purpose of this case series was to describe the authors' experience with intrathecal preservative-free normal saline challenge coupled with contrast-enhanced MR myelography (CEMRM), which was used to provoke and detect a CSF leakage site in patients with SIH. methods The authors performed a retrospective review of the records of patients who underwent preservative-free normal saline challenge followed by intrathecal gadolinium (Gd) contrast infusion and MR myelography from 2010 to 2012. results The records survey identified 5 patients who underwent 6 procedures. Intrathecal preservative-free normal saline challenge followed by CEMRM identified a CSF leak during 5 of the 6 procedures. Previous CT myelograms were available from 4 patients, which did not reveal a leakage site. A CT myelogram of 1 patient showed a single leak, but the authors' saline challenge-CEMRM technique identified multiple additional leakage sites. Three patients exhibited transient postprocedural symptoms related to the saline infusion, but no long-term or permanent adverse effects related to the procedure were observed. coNclusioNs Instillation of preservative-free normal saline into the thecal sac followed by intrathecal Gd infusion is a safe technique that may increase the detection of a CSF leak on MR myelography images in patients with SIH.

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Section: Resultsmentioning

confidence: 99%

“…Additional symptoms may include dizziness, tinnitus, vomiting, altered mental status, and behavioral changes. 10,11,16 Findings on routine brain CT and MRI scans help to confirm a clinical suspicion of SIH. …”

mentioning

confidence: 99%

Intrathecal preservative-free normal saline challenge magnetic resonance myelography for the identification of cerebrospinal fluid leaks in spontaneous intracranial hypotension

Griauzde¹,

Gemmete²,

Pandey³

et al. 2015

JNS

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“…Other cardinal symptoms reported are nausea and vomiting occurred in about half of patients [8, 47], always accompanied by neck pain stiffness [26], blurred vision [12], “visual” filed defects and diplopia [48], cough headache [30], facial pain or numbness [49], tinnitus [41], taste alternations [8, 47] and limb paresthesias [50] and transient third cranial nerve palsy [51]. Neurocognitive decline such as dementia [52, 53], behavioral changes [54–56] and parkinsonism [57] also can be presented which is rarer but has also been report.…”

Section: Reviewmentioning

confidence: 99%

“…Intracranial hypotension is a well-recognized entity associated with CSF leakage [54]. Multiple imaging methods are highly applicative and valuable for suspicious CSF leakage diagnosis [34], while some matters are needed.…”

Section: Reviewmentioning

confidence: 99%

The status of diagnosis and treatment to intracranial hypotension, including SIH

Lin

Zhang

et al. 2017

J Headache Pain

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Intracranial hypotension, especially spontaneous intracranial hypotension (SIH), is a well—recognized entity associated with cerebrospinal fluid (CSF) leaks, and has being recognized better in resent years, while still woefully inadequate. An increasing number of factors including iatrogenic factors are realized to involve in development and progression of intracranial hypotension. The diagnosis remains difficult due to the various clinical manifestations, some of which are nonspecific and easily to be neglected. Multiple imaging tests are optional in CSF leakage identification while clinicians are still confronted with difficulties when making selection resulting from superiorities and disadvantages of different imaging tests. Treatments for intracranial hypotension are multifarious but evidence is anecdotal. Values of autologous epidural blood patching (EBP), the mainstay of first-line interventional treatment currently, is getting more and more regards while there are no systematic review of its efficacy and risks. Hereby, the purpose of this review was to reveal the present strategy of intracranial hypotension diagnosis and treatment by reviewing literatures, coupled with our experience in clinical work.

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“…Finding multiple sites of CSF leaks in occasional patients complicates matters further. Some authors have reported innovative techniques with blood patching at multiple sites using a single catheter access3 or the use of percutaneous fibrin glue sealant 1. If a patient's symptoms remain disabling, and there is a clearly identified site of CSF leak, and all treatment measures have failed, it is worth considering surgery.…”

mentioning

confidence: 99%

Management of spontaneous intracranial hypotension

Tyagi

2016

Pract Neurol

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Large-Volume Blood Patch to Multiple Sites in the Epidural Space through a Single-Catheter Access Site for Treatment of Spontaneous Intracranial Hypotension

Cited by 26 publications

References 18 publications

Intrathecal preservative-free normal saline challenge magnetic resonance myelography for the identification of cerebrospinal fluid leaks in spontaneous intracranial hypotension

Intrathecal preservative-free normal saline challenge magnetic resonance myelography for the identification of cerebrospinal fluid leaks in spontaneous intracranial hypotension

The status of diagnosis and treatment to intracranial hypotension, including SIH

Management of spontaneous intracranial hypotension

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