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- Title
A Case of Asymptomatic Rebound Intracranial Hypertension After Treatment of Spontaneous Intracranial Hypotension by Epidural Blood Patch.
- Authors
Ulaş, Ümit Hıdır; Karadaş, Ömer; Öz, Oğuzhan; Akgün, Hakan; Eroğlu, Erdal; Bek, Semai; Demirkaya, Şeref; Odabaşi, Zeki
- Abstract
Epidural blood patch (EBP) is the treatment of choice if non-invasive (bed rest, hydration) treatment is ineffective in spontaneous intracranial hypotension (SIH). However, the possibility of a rebound increase of intracranial pressure after EBP with sudden or slow onset is known. A 43-year-old female presented with orthostatic headache and diagnosed as SIH based on clinical, laboratory and imaging criteria. The opening cerebrospinal fluid (CSF) pressure was 60 mm of water. Radionuclide cisternography indicated thoracic CSF leakage. Epidural blood patch injected at thoracic level. In order to evaluate epidural space completely this procedure was made under fluoroscopic guidance. The localization was confirmed by injecting contrast material. Our case was symptom free after EBP treatment but a follow-up CSF opening pressure at the third week after EBP treatment was 250 mm of water that suggested a rebound intracranial hypertension. Cerebrospinal fluid pressure was successfully decreased with acetazolamide without the occurrence of high pressure symptoms. Our case differs from other reports of intracranial hypertension after EBP. In previously reported cases, headache was the clinical manifestation of intracranial hypertension. Our case was symptom free after EBP and intracranial hypertension was observed on a follow-up lumbar puncture (LP) examination, CSF pressure was successfully decreased with acetazolamide without the occurrence of high pressure symptoms. We presented a case of asymptomatic rebound intracranial hypertension after treatment of spontaneous intracranial hypotension that was observed on a follow-up LP examination, up to our knowledge previously unreported in published literature.
- Subjects
INTRACRANIAL hypertension; INTRACRANIAL pressure; HEADACHE; RADIOISOTOPES; CISTERNOGRAPHY; RADIOGRAPHY; BRAIN
- Publication
Journal of Neurological Sciences, 2010, Vol 27, Issue 2, p224
- ISSN
1300-1817
- Publication type
Case Study