Life-threatening spontaneous intracranial hypotension responding to epidural blood patch

Facilitated insertion of a nasogastric tube in tracheal intubated patients using the GlideScope

“…The literature suggests that the breach of the dura in SIH is most often at the cervical or thoracic level. 4 In our patient, the site of the dural tear was unknown. Exactly how the 'blind' epidural blood patch causes benefit in these cases is unclear but, as in those reported by Buguet-Brown and colleagues, 1 we found it to be rapidly effective.…”

Spontaneous intracranial hypotension presenting with coma: case report and review of the literature

“…[5] Radiological features in cases with coma are subdural fluid collections/ hematoma, increasingly attenuated basilar cisterns, cerebral edema, diffuse enhancement of meninges and downward displacement of diencephalon and cerebellar tonsils. [6][7][8][9] According to Monro-Kellie hypothesis decreased cerebrospinal fluid pressure results in venous congestion resulting in enhancement of meninges or subdural collection which may cause herniation and mental decline. However, Savoiardo et al [10] reported increased diffusivity in diencephalo-mesencehalic structures by MRI in patients with brain sagging which is suggested to reflect vasogenic edema in those deep structures.…”

“…[2,7,8] Although evacuation of subdural collections provides transient improvements, this effect is not persistent. In few cases where EBP did not benefit epidural interventions like fibrin glue enjection [6] or saline infusion [3] reversed symptoms.…”

Intracranial Hypotension Causing Reversible Frontotemporal Dementia and Coma

“…Failing conservative medical management, one should consider the use of an epidural blood patch to seal dural CSF leaks 5,9,10,19,28,29,31,32 . The proposed mechanism for the efficacy of blood patching is two fold: an initial displacement of the dura towards the spinal cord moves peri-spinal CSF into cranium, thus immediately increasing intracranial CSF volume, pressure and buoyancy forces; and later, as blood coagulates at the leak site, further CSF loss is prevented.…”