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Successful management of spontaneous intracranial hypotension with epidural blood patch
  1. Amanda Ebejer1,
  2. Mithila Vijay2 and
  3. Thinzar Min2
  1. 1Department of Anaesthetics, Morriston Hospital, Swansea, UK
  2. 2Department of Internal Medicine, Morriston Hospital, Swansea, UK
  1. Correspondence to Dr Mithila Vijay; mithilavijay18{at}gmail.com

Abstract

Spontaneous intracranial hypotension (SIH) is characterised by postural headache and a cerebrospinal fluid (CSF) pressure of ≤6 cmH20 measured with the patient in the lateral decubitus position. Other symptoms include tinnitus, altered hearing, diplopia, photophobia, nausea and neck stiffness, and must not have occurred within a month of dural puncture. Symptoms typically remit after normalisation of CSF pressure or successful sealing of the CSF leak. An epidural blood patch (EBP) is a treatment option in those who have not responded to bed rest, fluids, non-steroidal anti-inflammatories or caffeine. We present a case of SIH successfully treated with both conservative measures and EBP. We compare our case with similar cases in the literature and summarise what is known about EBP for SIH to help clinicians take a more informed approach to managing such patients.

  • anaesthesia
  • headache (including migraines)
  • spinal cord
  • neurology

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Footnotes

  • Contributors Lead author: AE. Second author: MV. Co-author: TM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.