RESUMO
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.
Assuntos
Placa de Sangue Epidural/instrumentação , Placa de Sangue Epidural/métodos , Catéteres , Hipotensão Intracraniana/terapia , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeAssuntos
Placa de Sangue Epidural/métodos , Vazamento de Líquido Cefalorraquidiano/complicações , Fluoroscopia/métodos , Cefaleia/terapia , Hipotensão Intracraniana/terapia , Placa de Sangue Epidural/instrumentação , Catéteres , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vértebras Cervicais/diagnóstico por imagem , Fluoroscopia/instrumentação , Cefaleia/etiologia , Humanos , Hipotensão Intracraniana/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas/diagnóstico por imagem , Resultado do TratamentoRESUMO
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.
Assuntos
Placa de Sangue Epidural/instrumentação , Placa de Sangue Epidural/métodos , Hipotensão Intracraniana/etiologia , Hipotensão Intracraniana/terapia , Derrame Subdural/complicações , Derrame Subdural/terapia , Adulto , Estudos de Viabilidade , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Masculino , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Radiografia Intervencionista/métodos , Derrame Subdural/diagnóstico por imagem , Resultado do TratamentoAssuntos
Anestesia Epidural/instrumentação , Placa de Sangue Epidural/instrumentação , Cateterismo/instrumentação , Cefaleia Pós-Punção Dural/terapia , Anestesia Epidural/métodos , Placa de Sangue Epidural/métodos , Cateterismo/métodos , Remoção de Dispositivo/métodos , Falha de Equipamento , HumanosRESUMO
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.
Assuntos
Doenças do Nervo Abducente/terapia , Placa de Sangue Epidural , Punção Espinal/efeitos adversos , Doenças do Nervo Abducente/etiologia , Anestesia Epidural , Placa de Sangue Epidural/instrumentação , Placa de Sangue Epidural/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Falha de TratamentoRESUMO
No disponible
Assuntos
Humanos , Placa de Sangue Epidural/métodos , Cateterismo/métodos , Cefaleia/terapia , Testemunhas de Jeová , Aceitação pelo Paciente de Cuidados de Saúde , Braço/irrigação sanguínea , Placa de Sangue Epidural/instrumentação , Injeções/instrumentação , Injeções/métodos , SeringasRESUMO
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.
