Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Epidural blood patch (EBP) is routinely used to treat spontaneous intracranial hypotension (SIH). In the case of a patient receiving dual antiplatelet therapy, a caudal EBP was utilized for treatment of his SIH-related chronic headache as the traditional lumbar interlaminar approach was not advisable due to bleeding risk. While there are case reports supporting the efficacy of caudal EPB for treating SIH, none of the cases were performed in patients receiving antiplatelet therapy. In this case, we were uncertain whether antiplatelet agents would interfere with clot formation in the epidural space and preclude successful blood patch formation.
CASE REPORT: Herein, we present a 50-year-old man diagnosed with SIH after presenting with a 2-month history of intractable, orthostatic, bifrontal headache. He had undergone coronary stenting 37 days prior and was receiving dual antiplatelet therapy with aspirin and clopidogrel. After the patient failed conservative measures, he elected to proceed with caudal EBP. This provided only 2 hours of symptom relief. One week later, another EBP was performed, this time with complete resolution of the patient’s headache.
CONCLUSION: Our case demonstrates that the caudal approach to EBP may be a safe and effective alternative to interlaminar blood patch for treatment of spontaneous intracranial hypotension in patients at increased bleeding risk related to antiplatelet therapy.
KEY WORDS: Epidural blood patch, caudal blood patch, CSF leak, postural headache, SIH, spontaneous intracranial hypotension, anticoagulation