| Title | Repeated large-volume epidural blood patches for the treatment of spontaneous intracranial hypotension. | | Author(s) | Mehta B, Tarshis J | | Institution | Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. | | Source | Can J Anaesth 2009 Jun 3. | | 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. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19495908 |
|
