Treatment of spontaneous intracranial hypotension with multiple leakage sites of cerebrospinal fluid : A case report

Spontaneous intracranial hypotension (SIH) is an uncommon disease that's caused by cerebrospinal fluid (CSF) leakage and this disease is considered to be an important cause of persistent headache. It is characterized by a postural headache in patients who are without any history of dural puncture or trauma. Conservative management, including bed rest analgesics and intravenous fluid administration, are the first-line treatment of SIH, and an autologous epidural blood patch (EBP) is generally indicated for those who fail the conservative management. We report here on a case of SIH with confirmed CSF leakage at the cervical, thoracic and lumbar levels, and this was successfully managed with a single autologous EBP at the lumbar level. We believe that an EBP at the leakage site with the highest pressure level should be considered as a primary treatment for SIH with multiple sites of leakage.

Successful Treatment of Epidural Abscess with Percutaneous Drainage: A case report / 대한마취과학회지

Continuous epidural analgesia is commonly used for chronic pain treatment as well as postoperative pain control. Epidural abscess is rare, but it is a serious complication of the continuous epidural analgesia, which leads to neurologic sequelae. Epidural catheter was inserted to a 87-year-old woman who complained of postherpetic neuralgia from T6 dermatome for continuous epidural analgesia. Two weeks later, neuralgia was aggravated along with back pain and tenderness around catheter insertion area. ESR and CRP level was also elevated. Epidural abscess was detected on MRI scan right after removal of catheter. It has been improved with percutaneous drainage via Tuohy needle with antibiotics without need for surgery. We conclude that percutaneous drainage with antibiotics is an effective method for the treatment of early diagnosed epidural abscess without neurologic deficit, especially in the high risk patients for operation.

Iatrogenic Vertebro-vertebral Arteriovenous Fistula Associated with Internal Jugular Vein Catheterization: A case report / 대한마취과학회지

Iatrogenic vertebro-vertebral arteriovenous fistula (AVF) is an uncommon complication resulting from various procedures such as central venous catheter insertion. The incidence may be underestimated since the diagnosis is not easy because of its rarity. A central venous catheterization via the internal jugular vein was attempted in a 43-year-old female who presented for intracranial aneurysmal clipping under general anesthesia. Inadvertent arterial puncture was recognized as pulsatile arterial blood flow through the needle. The needle was removed and local compression was applied to the puncture site. The catheter was inserted via the right femoral vein. After surgery, the patient recovered from anesthesia without any complications. On postoperative day 5, thrill and bruit on the right side of the neck were noted on physical examination. Angiography confirmed vertebro-vertebral AVF, which was successfully obliterated with a stent 3 months later.