ABSTRACT
Thirty-six spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid were enrolled in the study.After 30 patients received targeted epidural blood intervention for 2 times and 6 patients received targeted epidural blood intervention for 3 times,the clinical symptoms were completely relieved.During injection of autologous blood,pain at the puncture site occurred in 24 cases,radiating pain in upper extremities in 5 cases,numbness in the upper extremity in 9 cases,radiating pain in lower extremities in 6 cases,numbness in lower extremities in 7 cases,headache in 4 cases,dizziness in 3 cases and transient bradycardia in 3 cases.Most of these symptoms were self-relieved after the end of injection or after slowing the injection rate,and some were self-relieved hours later.Neck stiffness was found in 2 cases and self-relived within a few hours or days after operation,and no severe nervous systemrelated complications were found.Recurrence happened in 2 cases at 3 months after the end of treatment,and the symptoms were self-relieved after receiving targeted epidural blood intervention for a second time.The patients were followed up for 15-36 months,and no serious nervous system-related complications were observed.Therefore,targeted epidural blood intervention is safe and effective when used to treat spontaneous intracranial hypotension caused by multiple-level leakages of cerebrospinal fluid in patients.
ABSTRACT
JUSTIFICATIVA E OBJETIVOS: A cefaleia pós-punção dural é uma complicação possível e esperada em uma pequena parcela dos casos após a realização da raquianestesia. Este relato teve por objetivo descrever a conduta terapêutica tomada diante de um caso de cefaleia pós-punção de dura-máter com sete meses de evolução. RELATO DO CASO: Paciente do sexo feminino, 40 anos, previamente saudável, apresentou-se ao hospital em quadro de cefaleia com sete meses de duração e que teve início após a realização de raquianestesia. Ao ser examinada, relatou que alguns analgésicos e a posição de decúbito lhe traziam alívio parcial da dor. Após a suspeita de cefaleia pós-punção dural, realizou-se um tampão sanguíneo peridural, com resolução completa do quadro. Recebeu alta hospitalar sem queixas. CONCLUSÕES: O presente caso demonstrou que o tampão sanguíneo peridural foi eficaz no tratamento da cefaleia crônica pós-punção dural em um caso com sete meses de duração.
BACKGROUND AND OBJECTIVES: Post-dural puncture headache is a possible and expected complication in a small percentage of cases after spinal anesthesia. The objective of the current report was to describe the therapeutic conduct in a case of post-dural puncture headache with seven months of evolution. CASE REPORT: A 40-year-old healthy female who complained of headache for seven months, which began after spinal anesthesia. She reported that some analgesics and decubitus position provided partial pain relief. An epidural blood patch was performed, with complete resolution of pain. She was discharged without complaints. CONCLUSIONS: This case demonstrated that the epidural blood patch was effective in the treatment of chronic post-dural puncture headache in a case with seven-month evolution.
JUSTIFICATIVA Y OBJETIVOS: La cefalea postpunción dural es una complicación posible y esperada en una pequeña parte de los casos posteriores a la realización de la raquianestesia. Este relato quiso describir la conducta terapéutica tomada frente a un caso de cefalea postpunción de dura madre con siete meses de evolución. RELATO DEL CASO: Paciente del sexo femenino, 40 años, anteriormente sana, que se presentó en el hospital con un cuadro de cefalea con siete meses de duración y que se inició después de la realización de la raquianestesia. Al ser examinada, relató que algunos analgésicos y la posición de decúbito le aliviaban parcialmente el dolor. Después de sospechar de una cefalea postpunción dural, se realizó un tampón sanguíneo epidural, con la resolución completa del cuadro. Recibió alta sin quejarse. CONCLUSIONES: El presente caso demostró que el tampón sanguíneo epidural fue eficaz en el tratamiento de la cefalea crónica postpunción dural en un caso con siete meses de duración.
Subject(s)
Adult , Female , Humans , Post-Dural Puncture Headache/therapy , Time FactorsABSTRACT
Spontaneous intracranial hypotension (SIH) is caused by single or multiple cerebrospinal fluid (CSF) leaks in the spine with the prototypical symptom of postural headache. One of the characteristic MRI features in SIH is intracranial venous engorgement. This report presents a case of SIH with engorgement of the bilateral superior ophthalmic veins (SOVs) which resume their normal diameters by the third day of successful epidural blood patches (EBPs). We define this phenomenon as the "reversal of the SOV" sign.
Subject(s)
Aged , Humans , Male , Blood Patch, Epidural , Cerebrospinal Fluid Rhinorrhea/complications , Diagnosis, Differential , Intracranial Hypotension/diagnosis , Magnetic Resonance Imaging , Orbit/blood supplyABSTRACT
Six patients(3 male,3 female)aged 33-66 yr, Course of disease 6-35 days, diagnosed with spontaneous intracranial hypotemion in Sir Run Run Shaw Hospital from November 2007 to May 2008,Were treated with on epidural autologus blood patch trader X-ray guidance. According to the results of CT myelography. the puncture site Was chosen in the 1-2 vertebral interspaees below the site of a single eerebrospinal fluid leak. For patients with multiple cerebrospinal fluid leaks.the procedure was performed at the spinal cord segment of the most severe leak. The mixture of augous blood and Omnipaque(300g/100 ml)at a ratio of 2:1 was injected into the epidural space to cover the spinal cord segment of the leaks under C-arm fluoroscopic guidance.Side effects were recorded during and after the injection of autologus blood.The treatment was repeated one week later if the former one failed.One patient was treated with epidural blood patch 3 times.and the rest 5 patients were treated with epidural blood patch 1 time.During the injeetion of autologus blood,5 patients complained of pain in the purtclure site,2 experienced pain radiating to the upper limb,2 felt,numbness in the right leg and all of these syndromes could be self-relieved.No side effects were observed after the injection of autologus blood.All the patients were Cured and no recurrence was observed during a 2-6 month follow-up.