Repeated large-volume epidural blood patches for the treatment of spontaneous intracranial hypotension

Abstract

Purpose: Refractory headache from spontaneous intracranial hypotension can be debilitating for patients. This report describes the use of repeated high-volume epidural blood patches to treat this condition. Clinical features: A 39-yr-old male presented with a history and diagnostic imaging findings consistent with spontaneous intracranial hypotension. The associated intractable and incapacitating headache was unrelieved by meperidine and a 20 mL lumbar autologous blood patch. Two weeks later, a second epidural blood patch of 45 mL autologous blood administered in the lower thoracic epidural space achieved partial relief. With symptoms persisting despite oral analgesics, a third blood patch was undertaken one month after the initial procedure. On this occasion, administration of 32 mL autologous blood into the mid-thoracic epidural space resulted in complete and lasting resolution of the headache. Conclusion: The ideal volume of blood injectate to achieve maximal effectiveness for an epidural blood patch is unknown. While many clinicians use a predetermined maximal volume, a volume titrated to patient symptoms is a suggested alternate approach. © 2009 Canadian Anesthesiologists' Society.