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Management of post blood patch severe rebound intracranial hypertension by the usage of an external ventricular drain
  1. Leonardo Maresca1,
  2. Maria Fragale1,2,
  3. Giacomo Petrella1 and
  4. Davide Boeris1
  1. 1Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Lombardia, Italy
  2. 2Neurosurgery, University of Rome La Sapienza, Rome, Lazio, Italy
  1. Correspondence to Dr Davide Boeris; davide.boeris{at}


Spontaneous intracranial hypotension (SIH) is a condition characterised by postural headaches due to low cerebrospinal fluid (CSF) pressure, often stemming from CSF leakage. Diagnosis poses a significant challenge, and the therapeutic approach encompasses both conservative measures and operative interventions, such as the epidural blood patch (EBP). However, EBP carries the potential risk of inducing rebound intracranial hypertension (RIH), subsequently leading to high-pressure headaches. We present a case wherein RIH following EBP was effectively managed through the implementation of an external ventricular drain (EVD) aimed at reducing CSF pressure. The patient improved significantly, underscoring the potential utility, if not necessity, of EVD in carefully selected cases, highlighting the imperative for further research to enhance the management of SIH and optimise EBP-related complications.

  • Neurosurgery
  • Neurology
  • Clinical neurophysiology
  • Coma and raised intracranial pressure
  • Headache (including migraines)

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  • Contributors All authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. All authors gave final approval of the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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