Treatment Outcomes in Spontaneous Intracranial Hypotension: Do Epidural Blood Patches Stop the Leaks?

Abstract

Spontaneous intracranial hypotension (SIH) is a postural headache syndrome unrelated to dural puncture. Because of the increasing failure of epidural blood patch (EBP) to relieve headache in SIH, we retrospectively investigated the epidemiological features and treatment outcomes in 55 cases of SIH. The study population was stratified by age and sex; continuous variables were compared for differences by t-tests; categorical variables were compared by Chi-squared analysis or Fisher exact tests. Significant differences were identified by P values of 0.05 or less. The mean age of the study population was 44 +/- 12 years with a female to male ratio of 1.3:1.0. Men presented with subdural hematomas (P = 0.001) more often than women. Meningeal enhancement on contrast magnetic resonance imaging (MRI) was the most consistent radiographic finding. Radionuclide cisternography (RC) demonstrated thoracolumbar dural leaks in 16 of 22 patients. EBP failures were more common in patients aged 40 and younger than in older patients (P = 0.003). Postural headache from SIH was not uniformly responsive to EBP, and had significant comorbidities, especially in men. The management of postural headache in SIH by other techniques to restore brain position and cerebrospinal fluid dynamics should be investigated.

Antenatal blood patch in a pregnant woman with spontaneous intracranial hypotension

“…14 Although EBP has been reported to be effective in 70-100% of cases of PDPH, 9,16,17 a systematic review revealed less favourable results. 13 The use of EBP to treat PDPH in pregnancy has been described, [18][19][20] but to our knowledge there are no previous reports of EBP in the management of SIH in pregnancy.…”

“…4,5,[12][13][14][15] One such series recommends early and repeat EBP. 14 Although EBP has been reported to be effective in 70-100% of cases of PDPH, 9,16,17 a systematic review revealed less favourable results.…”

CT-Guided Epidural Blood Patching of Directly Observed or Potential Leak Sites for the Targeted Treatment of Spontaneous Intracranial Hypotension

“…While some series report success rates in excess of 80%, several studies have found success rates to be substantially lower, and several authors have reported success rates of Ͻ50%. 8,[10][11][12][13][14][15] In our series, 3 of 8 patients had failed multiple prior nontargeted lumbar epidural blood patches. Alternative treatment strategies for such patients are, therefore, important.…”

Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatment

“…3,10,16 In one report 2 of 6 patients with SIHS reportedly had complete symptom resolution after the first EBP, and only 4 patients were finally free of symptoms even after repeated EBPs. 10 In our series, the EBP was quite effective and most of our patients experienced a significant reduction of symptoms after 1 or 2 EBP injections.…”