自发性颅内低血压(SIH)是一种神经系统疾病,由于脑脊液从其水库流失,颅内压降低。鞘内空间,到周围的组织。它的特征通常是丧失行为能力的头痛,无音畏光,恶心,呕吐,通常难以治疗,需要进一步调查。我们描述了一个健康的年轻人出现姿势性头痛到急诊室的情况,伴有恶心,呕吐,和畏光。脑计算机断层扫描(CT)成像研究并不明显,最初对症治疗。因为即使在医疗上也会持续疼痛,额外的成像研究,包括骨髓CT扫描,进行了多层脑脊液瘘的诊断。为了治疗根本原因,最初在C7-T1用20mL自体血进行第一次硬膜外补血(EBP),但未能提供完全缓解症状。几个月后,第二次EBP在C6-C7以更大的体积(30mL)进行,但与第一次EBP一样,该程序也没有导致头痛和伴随症状的完全缓解.由于骨科和神经外科没有手术指征,症状持续存在,进行了第三次EBP,这次是在腰椎水平(L2-L3)输注60mL血液,从而达到上背侧和颈部硬膜外腔。这导致了更好的症状缓解,允许病人现在进行他的正常活动,只有残余的疼痛。需要重复手术是血液修补技术的陷阱之一。如果可能,它应该在记录在案的瘘管水平上进行,但始终牢记安全和经验丰富的双手,尤其是在宫颈水平方面。关于要施用的血容量尚未达成共识;然而,患者报告的任何不适或疼痛都应视为警告信号,并应中断手术。虽然不是一个完美的解决方案,EBP可以完全或部分缓解SIH症状,不需要手术干预。
Spontaneous intracranial hypotension (SIH) is a neurologic condition where the intracranial pressure is reduced due to a loss of cerebrospinal fluid from its reservoir, the intrathecal space, to surrounding tissues. It is commonly characterized by an incapacitating headache, phono-photophobia, nausea, and vomiting, commonly refractory to medical treatment and requires further investigation. We describe the case of a healthy young man who presented to the emergency room with a postural headache, accompanied by nausea, vomiting, and phono-photophobia. Brain computed tomography (CT) imaging study was unremarkable and he was initially treated symptomatically. Because of persisting pain even on medical treatment, additional imaging studies, including a myelo-CT scan, were performed and a diagnosis of multi-level cerebrospinal fluid fistulas was made. To treat the underlying cause, a first epidural blood patch (EBP) was initially performed at C7-T1 with 20 mL of autologous blood, but failed to provide complete symptomatic relief. Months later, a second EBP was conducted at C6-C7 with higher volume (30 mL) but as in the first EBP this procedure too did not result in total resolution of the headache and accompanying symptoms. Since there was no surgical indication from Orthopedics and Neurosurgery and the symptoms persisted, a third EBP was carried out, this time at a lumbar level (L2-L3) with infusion of 60 mL of blood so the upper dorsal and cervical epidural space was reached. This resulted in a better symptom relief, allowing the patient to now carry out his normal activities with only residual pain. The need for repeat procedures is one of the pitfalls of the blood patching technique. If possible, it should be performed at the level of the documented fistula, but always with safety in mind and by experienced hands, especially when cervical levels are concerned. A consensus has not been reached regarding the blood volume to be administered; however, any discomfort or pain reported by the patient should be seen as warning sign and the procedure should be interrupted. Although not being a perfect solution, EBP can completely or partially resolve SIH symptoms, without the need for surgical intervention.