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Lack of Increase in Intracranial Pressure After Epidural Blood Patch in Spinal Cerebrospinal Fluid Leak.
MedLine Citation:
PMID:  22528279     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND IMPORTANCE: Epidural blood patch (EBP) is one therapeutic measure for patients suffering from spontaneous intracranial hypotension (SIH) or post-lumbar puncture headaches. It has been proposed that an EBP may directly seal a spinal cerebrospinal fluid (CSF) fistula or result in an increase in intracranial pressure (ICP) by a shift of CSF from the spinal to the intracranial compartment. To the best of our knowledge this is the first case of a patient with SIH and neurological deterioration in whom ICP was measured before, during, and after spinal EBP. CLINICAL PRESENTATION: This 52-year old previously healthy man presented with holocephal headaches. MRI showed a left hemispheric subdural fluid collection causing a significant mass effect. Myelography revealed a CSF leak with epidural contrast at the left side of the L-2 level. To seal the CSF leak, we performed an EBP procedure targeted at left L-2 level and recorded ICP. After applying the epidural blood patch (15 cc) the patient improved rapidly, ICP however remained unchanged before, during, and after the procedure. One day post-treatment, he had a GCS score increase from 12 to 15 and no headache or neurological deficits. CONCLUSION: A shift of CSF from the spinal to the cranial compartment with a subsequent rise in ICP might not be a beneficial therapeutic mechanism of spinal epidural blood patching.
Authors:
Jens Fichtner; Christian Fung; Werner Z Graggen; Andreas Raabe; Jürgen Beck
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-17
Journal Detail:
Title:  Neurocritical care     Volume:  -     ISSN:  1556-0961     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Neurosurgery, Bern University Hospital, Publications Office, 3010, Bern, Switzerland.
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