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REGIONAL ANESTHESIA

Intracranial Hypotension Caused by Cervical Cerebrospinal Fluid Leak: Treatment with Epidural Blood Patch

Michael J. Cousins^*, David Brazier, and Raymond Cook

Departments of *Anaesthesia and Pain Management, Radiology, and Neurosurgery, University of Sydney and Royal North Shore Hospital, St. Leonards, Australia

Address correspondence and reprint requests to Michael J. Cousins, Pain Management Research Institute, Royal North Shore, St. Leonards, 2065 NSW Australia. Address e-mail to mcousins{at}doh.health nsw.gov.au.

This report describes treatment with cervical epidural blood patch of low cerebrospinal fluid (CSF) pressure headache resulting from spontaneous CSF leak via a tear in a cervical dural cuff. The leak was diagnosed by a dynamic computed tomography (CT)-myelography study followed by gadolinium enhanced magnetic resonance imaging(MRI)-scan. The epidural needle was inserted with the aid of image intensifier and CT-scan to guide the needle to the precise site of the CSF leak. Blood mixed with gadolinium was injected, and subsequent MRI scanning provided the first description of spread of blood after cervical epidural blood patch.

IMPLICATIONS:Low cerebrospinal fluid (CSF) pressure may cause severe posturally-related headache. In the patient, a vertebral disc protrusion in the neck seems to have contributed to a CSF leak. An injection of blood into the epidural space at the precise site of the CSF leak was followed by complete and lasting resolution of the headache.

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