Epidural blood patch with 30 ml of autologous blood under fluoroscopic guidance in spontaneous intracranial hypotension: a case report

Abstract

We report a patient with spontaneous intracranial hypotension who developed repeated subdural hematoma despite removal of the hematoma. Epidural blood patch with 30 ml of autologous blood under fluoroscopic guidance resolved the headache. There was no recurrence of subdural hematoma or headache after applying the epidural blood patch. A 51-year-old man had postural headache after awakening in the morning. Since the headache gradually worsened, he was admitted to our hospital, 6 days after the onset. Nausea and tinnitus accompanied the headache. Computed tomography (CT) of the head showed bilateral subdural hygroma, and magnetic resonance imaging (MRI) demonstrated enhanced images of the pachymeninges. His course was complicated with repeated bilateral subdural hematoma with deterioration of the consciousness. He received evacuation of the hematoma; however, severe postural headache persisted after the surgery. Radionuclide cisternogram showed early accumulation of radioactivity in the urinary bladder. MRI of the spine and CT myelogram revealed the presence of extradural effusion ranging from T2 to T8. Autologous blood 12 ml was injected through T4/5 and 18 ml through T6/8, under fluoroscopic guidance. The headache promptly resolved after the autologous epidural blood patch. There was no recurrence of subdural hematoma or complication related to epidural blood patch.