Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
PDF
BACKGROUND: Background: Although intracranial hypotension is a relatively frequent problem after spinal taps, spontaneous intracranial hypotension is a rare disease. The most common cause is spontaneous spinal leak. Conservative treatment is usually the first option for these patients. If conservative measures fail, the treatment of choice is administration of an epidural blood patch (EBP). CASE REPORT: In our case a 44-year old female patient was admitted to the emergency department with the complaint of severe throbbing pain in the back of her neck that radiated to the frontal region. The transverse T2 space imaging scans at the cervical level showed flow void in the anterior side of the dura in the cross-section passing through the upper plateau of the cervical vertebra 7.
The patient was hospitalized with the diagnosis of intracranial hypotension. After one week of conservative treatment, her symptoms did not regress so an epidural blood patch was considered.
Nineteen mL of homologous blood was injected into the epidural space. She was kept in prone Trendelenburg position for 30 minutes. At post-operative hour 2, she told that her headache was relieved and the nausea stopped. She was headache free on her control examinations at week 1 and 1, 3, 6 month.
CONCLUSION: There are cases where EBP was applied primarily from the lumbar region for dural leakage in the cervical region, but then EBP was applied from the cervical region because the symptoms did not resolve. Our patient’s symptoms have completely resolved. In this result, we think that keeping the patient in the Trandelenburg position for about half an hour after EBP is effective.
KEY WORDS: Intracranial hypotension, epidural blood patch, Trandelenburg position
