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| 21KF-042 |
Subdural hemorrhage induced by Epidural blood patch in patient with Spontaneous intracranial hypotension : Case report
Department of Anesthesiology and Pain medicine, Bucheon St. Mary\'s Hospital, College of Medicine,
The Catholic University of Korea, Seoul, Republic of Korea
Background
Cerebrospinal fluid (CSF) leakage is considered to be the primary cause of spontaneous intracranial hypotension (SIH). And Subdural hemorrhage or heamatoma (SDH) is known as a serious complication of SIH. There are several reports that EBP is considered as a viable treatment choice for SDH induced by SIH. But paradoxically EBP as a treatment option can also induce acute SDH. Here we present a case of acute SDH in patient treated with EBP for SIH.
Case
A 58-year-old man complained chronic, ongoing headache over 2 months. Magnetic resonance imaging (MRI) showed chronic subdural fluid collection in left cerebral surface and right parietal surface. He was diagnosed subdural hemorrhage due to intracranial hypotension. Conservative care was done, but there was no improvement and consulted to anesthesiology department. He received first EBP at L4-5 Level, and there was no improvement. So second EBP was done in 2 days. After 2 times EBP, suddenly aggravated headache was appeared. New CT brain imaging showed acute SDH combined to chronic SDH along left cerebral surface. As it progressed to left lateral ventricle compression, Burr-hole trephination was done, and his headache was finally resolved.
Conclusion
The causes of SDH induced by SIH is explained in two ways. First is rupture of bridging veins pulled away from the dura due to low intracranial pressure. Another possible mechanism is that subdural fluid collections could gradually enlarges the subdural space, and the bridging veins are stretched and ruptured. Absolute Bed rest, fluid therapy can be treamtents of SDH induced by SIH. But when these conservative treatments are ineffective, EBP is suggested as a treatment of choice for long-lasting clinical results. The goal of this procedure is to help in reversing the blood gradient within the epidural space along the entire cord. But it can also enlarges the subdural space, which leads to strechging and rupture of the bridging veins like in this case. This case highlights that in SDH patient with SIH, EBP should be implemented cautiously with imaging follow up. And also we have to reconsider about volume of blood injected when retry EBP in short term.
Reference
Lai TH, Fuh JL, Lirng JF, Tsai PH, Wang SJ. Subdural haematoma in patients with spontaneous intracranial hypotension.Cephalalgia. 2007;27(2):133-138. doi:10.1111/j.1468-2982.2006.01249.x
Cerebrospinal fluid (CSF) leakage is considered to be the primary cause of spontaneous intracranial hypotension (SIH). And Subdural hemorrhage or heamatoma (SDH) is known as a serious complication of SIH. There are several reports that EBP is considered as a viable treatment choice for SDH induced by SIH. But paradoxically EBP as a treatment option can also induce acute SDH. Here we present a case of acute SDH in patient treated with EBP for SIH.
Case
A 58-year-old man complained chronic, ongoing headache over 2 months. Magnetic resonance imaging (MRI) showed chronic subdural fluid collection in left cerebral surface and right parietal surface. He was diagnosed subdural hemorrhage due to intracranial hypotension. Conservative care was done, but there was no improvement and consulted to anesthesiology department. He received first EBP at L4-5 Level, and there was no improvement. So second EBP was done in 2 days. After 2 times EBP, suddenly aggravated headache was appeared. New CT brain imaging showed acute SDH combined to chronic SDH along left cerebral surface. As it progressed to left lateral ventricle compression, Burr-hole trephination was done, and his headache was finally resolved.
Conclusion
The causes of SDH induced by SIH is explained in two ways. First is rupture of bridging veins pulled away from the dura due to low intracranial pressure. Another possible mechanism is that subdural fluid collections could gradually enlarges the subdural space, and the bridging veins are stretched and ruptured. Absolute Bed rest, fluid therapy can be treamtents of SDH induced by SIH. But when these conservative treatments are ineffective, EBP is suggested as a treatment of choice for long-lasting clinical results. The goal of this procedure is to help in reversing the blood gradient within the epidural space along the entire cord. But it can also enlarges the subdural space, which leads to strechging and rupture of the bridging veins like in this case. This case highlights that in SDH patient with SIH, EBP should be implemented cautiously with imaging follow up. And also we have to reconsider about volume of blood injected when retry EBP in short term.
Reference
Lai TH, Fuh JL, Lirng JF, Tsai PH, Wang SJ. Subdural haematoma in patients with spontaneous intracranial hypotension.Cephalalgia. 2007;27(2):133-138. doi:10.1111/j.1468-2982.2006.01249.x
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