Image-guided epidural blood patch as effective treatment of intracranial hypotension. A case report
Service de Neurologie, CHU Bretonneau, 37044 Tours Cedex.Neurochirurgie (Impact Factor: 0.41). 04/2003; 49(1):51-4.
We report the case of a patient with postural headache. A CT scan revealed bilateral subdural hygroma. Brain MRI showed diffuse pachymeningeal enhancement. A diagnosis of intracranial hypotension was therefore made. Thoracic cerebrospinal fluid leak was proved by radionuclide cisternography and contrast myelography. Conservative medical treatment was ineffective. Two thoracic epidural blood patches with radiographic control were made. We think the blood patch is the most important element for success.
Article: Blood patchLe Praticien en Anesthésie Réanimation 10/2007; 11(5):404–405. DOI:10.1016/S1279-7960(07)74235-3
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ABSTRACT: A case of spontaneous intracranial hypotension (SIH) caused by a cerebrospinal fluid (CSF) leak at C1-2 is described. The patient, a 46-year-old gentleman, presented to the emergency department with a severe, orthostatic neck pain and occipital headache of sudden onset. He was diagnosed with SIH and admitted, but failed to respond to conservative management. Imaging studies suggested that C1-2 was the spinal level responsible for the CSF leak, and he underwent a blood patch therapy delivered via an epidural catheter inserted from C6-7. His neck pain disappeared a day after the procedure, and he remains free of symptom for more than a year. SIH with a CSF leak at the upper cervical spine may be least amenable to conventional epidural blood patch delivered from the lumbar spine. Delivery of autologous blood patch via an epidural catheter inserted from the lower cervical spine can be a safe and effective method for such patients.Clinical Neurology and Neurosurgery 11/2007; 109(8):716-9. DOI:10.1016/j.clineuro.2007.05.006 · 1.13 Impact Factor
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ABSTRACT: The spinal canal is divided into epidural, subdural and subarachnoid spaces. Intraspinal processes should be correctly placed into their space of origin. MRI is the best imaging modality to achieve this task. Accurate determination of the space of origin routinely requires the acquisition of two different pulse sequences, typically T1W and T2W images, in two orthogonal planes, usually axial and sagittal. Simple imaging features can assist in determining the site of origin: changes to the epidural fat, compression or widening of subarachnoid spaces. The epidural space, bordered medially by dura, contains fat and vascular structures. The subdural space is a virtual space in between the dura and arachnoid membrane. The subarachnoid space is home to the CSF, spinal cord and nerve rootlets. An epidural process replaces the epidural fat, displaces the dura and narrows the subarachnoid space. A subarachnoid process widens the subarachnoid space and spares the epidural fat. Epidural processes usually are infectious or tumoral, either primary or secondary to spinal involvement. Subarachnoid processes include primary tumors, leptomeningeal metastases, arachnoiditis and hemorrhage. Nerve sheath tumors and meningiomas are the most frequent intradural extramedullary tumors.Journal de Radiologie 09/2010; 91(9):950-968. DOI:10.1016/S0221-0363(10)70142-6 · 0.57 Impact Factor
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