ABSTRACT
BACKGROUND: Epidural "blood patch" (EBP) is a standard treatment of spontaneous intracranial hypotension (SIH). In recent years, there are some reports of Racz catheter use for EBP performance at upper cervical spine levels. However, the practical use of Racz catheter for single-entry multisite EBP has never been reported until now. CASE DESCRIPTION: We treated a 60-year-old man diagnosed with SIH presenting with cerebrospinal fluid leaks from the cervical to the sacral segments. We discuss the advantages of the single-entry multisite EBP and the convenience of Racz catheter use in such cases. CONCLUSIONS: The Racz catheter can be a convenient means to deliver large-volume EBPs from a single entry point in the treatment of SIH.
Subject(s)
Blood Patch, Epidural/instrumentation , Blood Patch, Epidural/methods , Catheters , Intracranial Hypotension/therapy , Humans , Intracranial Hypotension/diagnostic imaging , Male , Middle AgedSubject(s)
Blood Patch, Epidural/methods , Cerebrospinal Fluid Leak/complications , Fluoroscopy/methods , Headache/therapy , Intracranial Hypotension/therapy , Blood Patch, Epidural/instrumentation , Catheters , Cerebrospinal Fluid Leak/diagnosis , Cervical Vertebrae/diagnostic imaging , Fluoroscopy/instrumentation , Headache/etiology , Humans , Intracranial Hypotension/etiology , Magnetic Resonance Imaging , Male , Middle Aged , Thoracic Vertebrae/diagnostic imaging , Treatment OutcomeABSTRACT
The dorsal epidural blood patch is a commonly used management technique for spontaneous intracranial hypotension from a dural CSF leak, but it may be less efficacious for cervical or ventral leaks. We report the technique of placing an anterior cervical blood patch for a large cervical ventral leak. To our best knowledge, this approach has not been reported. In the appropriately selected patient, an anterior cervical epidural blood patch may be safely used.
Subject(s)
Blood Patch, Epidural/instrumentation , Blood Patch, Epidural/methods , Intracranial Hypotension/etiology , Intracranial Hypotension/therapy , Subdural Effusion/complications , Subdural Effusion/therapy , Adult , Feasibility Studies , Humans , Intracranial Hypotension/diagnostic imaging , Male , Neck/diagnostic imaging , Neck/surgery , Radiography, Interventional/methods , Subdural Effusion/diagnostic imaging , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Intracranial Hypotension/drug therapy , Blood Patch, Epidural/instrumentation , Blood Patch, Epidural/methods , Intracranial Hypotension/therapy , Intracranial HypotensionSubject(s)
Anesthesia, Epidural/instrumentation , Blood Patch, Epidural/instrumentation , Catheterization/instrumentation , Post-Dural Puncture Headache/therapy , Anesthesia, Epidural/methods , Blood Patch, Epidural/methods , Catheterization/methods , Device Removal/methods , Equipment Failure , HumansABSTRACT
PURPOSE: To describe a case of iatrogenically induced abducens nerve palsy following a diagnostic lumbar puncture, and to review the evidence for blood patching in the management of sixth cranial nerve palsy after dural puncture. CLINICAL FEATURES: A 45-yr-old woman developed post-dural puncture headache with bilateral abducens palsy following a diagnostic lumbar puncture. Magnetic resonance imaging showed findings compatible with intracranial hypotension. An epidural blood patch was performed five days after the onset of diplopia and ten days following the dural puncture. After blood patching, the patient reported relief of the headache, but still complained of diplopia. The palsies recovered spontaneously 21 months after the dural puncture. CONCLUSION: Experience from this case as well as other case report evidence suggest that an epidural blood patch performed more than 24 hr after the onset of a sixth cranial nerve palsy consistently fails to relieve diplopia. An epidural blood patch executed within 24 hr from the onset of diplopia could possibly lead to partial improvement and/or earlier resolution of symptoms.
Subject(s)
Abducens Nerve Diseases/therapy , Blood Patch, Epidural , Spinal Puncture/adverse effects , Abducens Nerve Diseases/etiology , Anesthesia, Epidural , Blood Patch, Epidural/instrumentation , Blood Patch, Epidural/methods , Female , Humans , Middle Aged , Time Factors , Treatment FailureABSTRACT
No disponible
Subject(s)
Humans , Blood Patch, Epidural/methods , Catheterization/methods , Headache/therapy , Jehovah's Witnesses , Patient Acceptance of Health Care , Arm/blood supply , Blood Patch, Epidural/instrumentation , Injections/instrumentation , Injections/methods , SyringesABSTRACT
A 40-yr-old woman received a series of three interlaminar epidural steroid injections for the treatment of axial neck pain secondary to degenerative disc disease. Immediately after her third injection, she experienced symptoms of a dural puncture-induced headache. This headache persisted on a daily basis for 3 mos, despite two epidural blood patches using an interlaminar approach, which was finally completely abated with a transforaminal blood patch. The headache was immediately relieved and remained alleviated through the follow-up interval of 1 yr. In this patient, a fluoroscopically guided transforaminal epidural blood patch proved to be more effective than the classic blind interlaminar approach in the treatment of post-dural puncture headache.