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Epidural Blood Patch

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https://www.readbyqxmd.com/read/29777885/posttraumatic-cerebrospinal-fluid-leak-associated-with-an-upper-cervical-meningeal-diverticulum
#1
Noriya Enomoto, Hideo Mure, Toshiyuki Okazaki, Mai Azumi, Shinya Okita, Shinji Nagahiro, Yasushi Takagi
Spontaneous intracranial hypotension (SIH) has been increasingly recognized as a phenomenon caused by cerebrospinal fluid (CSF) leaks; however, its pathogenesis is still unclear. Here, we report two cases of SIH as a result of CSF leak from a meningeal diverticulum at the C2 nerve root sleeve. The first case is that of a 46-year-old man who had suffered from orthostatic headache after a bicycle accident at age 45. Computed tomography (CT) myelography revealed CSF leaks at the C1/2 level. He underwent epidural blood patch (EBP) therapy, but it was unsuccessful...
May 16, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29765818/targeted-epidural-blood-patch-treatment-for-refractory-spontaneous-intracranial-hypotension-in-china
#2
Fei-Fang He, Li Li, Min-Jun Liu, Tai-Di Zhong, Qiao-Wei Zhang, Xiang-Ming Fang
Objective  An epidural blood patch (EBP) is the mainstay of treatment for refractory spontaneous intracranial hypotension (SIH). We evaluated the treatment efficacy of targeted EBP in refractory SIH. Methods  All patients underwent brain magnetic resonance imaging (MRI) with contrast and heavily T2-weighted spine MRI. Whole spine computed tomography (CT) myelography with non-ionic contrast was performed in 46 patients, and whole spine MR myelography with intrathecal gadolinium was performed in 119 patients...
June 2018: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/29761781/-post-dural-puncture-headache
#3
Andreas Ravn, Louise Feldborg Lyckhage, Rigmor Jensen
Post-dural puncture headache (PDPH) is a frequent complication to procedures involving dural puncture. The condition is caused by excessive leakage of cerebrospinal fluid through the puncture, and it is most often seen in young women. The risk can be significantly reduced by using smaller, atraumatic needles. PDPH is characterised by a dull headache, which worsens in postural position. Usually, PDPH is a self-limiting condition, which resolves within a week with conservative treatment, but it may become chronic...
May 14, 2018: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29686805/efficacy-of-bilateral-greater-occipital-nerve-block-in-postdural-puncture-headache-a-narrative-review
#4
REVIEW
Abhijit S Nair, Praveen Kumar Kodisharapu, Poornachand Anne, Mohammad Salman Saifuddin, Christopher Asiel, Basanth Kumar Rayani
The Epidural blood patch is considered the gold standard for managing postdural puncture headache when supportive measures fail. However, it is a procedure which can lead to another inadvertent dural puncture. Other potential adverse events that could occur during a blood patch are meningitis, neurological deficits, and unconsciousness. The bilateral greater occipital nerve block has been used for treating chronic headaches in patients with PDPH with a single injection. This minimally invasive, simple procedure can be considered for patients early, along with other supportive treatment, and an epidural blood patch can be avoided...
April 2018: Korean Journal of Pain
https://www.readbyqxmd.com/read/29652685/blood-patch-in-a-jehovah-s-witness-case-report-of-a-novel-arterial-to-epidural-closed-circuit-technique
#5
Kevin R Olsen, Ashley L Screws, Stephen O Vose
Jehovah's Witness patients have unique perioperative challenges involving blood products. We describe the use of a novel method to maintain a closed circuit between a Jehovah's Witness patient's arterial blood and the epidural space while performing a blood patch for postdural puncture headache. Previously described methods have utilized venous catheters to maintain a closed circuit between the body and the epidural space. This is the first report we are aware of that utilizes a closed-circuit arterial blood supply to create an epidural blood patch in a Jehovah's Witness patient...
April 15, 2018: A&A practice
https://www.readbyqxmd.com/read/29629045/iatrogenic-development-of-cerebrospinal-fluid-leakage-in-diagnosing-spontaneous-intracranial-hypotension
#6
Chang-Joon Lee, Sung-Min Shim, Sang-Hyeon Cho, Jae-Ho Park, Young Ki Kim
A 34-year-old woman came to the emergency room complaining of a severe orthostatic headache. Results of a cerebrospinal fluid tap and brain computed tomography were normal. Based on her history and symptoms, she was found to have spontaneous intracranial hypotension. She was hospitalized and her symptoms improved with conservative treatment. On the next day, her headache suddenly worsened. Cisternography was performed to confirm the diagnosis and determine the spinal level of her cerebrospinal fluid leak. It revealed multiple cerebrospinal fluid leaks in the lumbar and upper thoracic regions...
March 2018: Korean Journal of Family Medicine
https://www.readbyqxmd.com/read/29600909/spontaneous-occult-intracranial-hypotension-precipitating-life-threatening-cerebral-venous-thrombosis-case-report
#7
Avital Perry, Christopher S Graffeo, Waleed Brinjikji, William R Copeland, Alejandro A Rabinstein, Michael J Link
Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia...
March 30, 2018: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/29534203/behavioral-variant-frontotemporal-dementia-as-a-serious-complication-of-spontaneous-intracranial-hypotension
#8
Wouter I Schievink, M Marcel Maya, Zachary R Barnard, Franklin G Moser, Stacey Jean-Pierre, Alan D Waxman, Miriam Nuño
BACKGROUND: Behavioral variant frontotemporal dementia (bvFTD) is a devastating early onset dementia. Symptoms of bvFTD may be caused by spontaneous intracranial hypotension (SIH), a treatable disorder, but no comprehensive study of such patients has been reported. OBJECTIVE: To describe detailed characteristics of a large cohort of patients with SIH and symptoms of bvFTD. METHODS: We identified patients with SIH who met clinical criteria for bvFTD...
March 8, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29497683/subdural-hematoma-after-cesarean-delivery-without-symptoms-a-case-report
#9
Syuhei Domoto, Manzo Suzuki, Shinpei Suzuki, Hiroyasu Bito
Background: Subdural hematoma (SDH) after accidental dural puncture (ADP) is rare but may be lethal. We experienced a patient who developed SDH after combined spinal and epidural anesthesia without a headache. Case presentation: A 41-year-old parturient female with an unruptured cerebral aneurysm, was scheduled to undergo elective cesarean delivery. Cerebrospinal fluid leakage was identified during puncture of the epidural space, and a catheter was placed after re-puncture...
2018: JA Clinical Reports
https://www.readbyqxmd.com/read/29497531/blood-patch-for-the-treatment-of-post-dural-puncture-tinnitus
#10
Wei Jia, Fiqry Fadhlillah
Audiometric disturbances are recognised as potential complications after spinal or epidural anaesthesia; however, incidences of tinnitus occur less frequently. We report a case of a patient with severe bilateral tinnitus post-lumbar puncture who was treated with an epidural blood patch. A 40-year-old ASA I lady (a medically fit patient with no known medical problem) presented with ongoing bilateral severe tinnitus for 6 days after a lumbar puncture. Venous blood (18 mL) was injected into the epidural space using a 16G needle...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29491335/-cerebrospinal-fluid-leakage-and-abducens-nerve-palsy-caused-by-bowling-activity
#11
Hiroyasu Inoue, Masaya Takemoto, Masahiro Muto, Taro Kitamura, Kentaro Yamada
Cerebrospinal fluid leakage can develop due to traffic trauma or lumbar puncture; however, in many cases, it develops spontaneously without any obvious cause. This report describes a case of cerebrospinal fluid leakage caused by bowling activity. A 57-year-old woman adjusted her bowling form, which led to the development of an orthostatic headache and double vision. Cerebrospinal fluid leakage and right abducens nerve palsy was diagnosed, which was resistant to conservative treatment. An epidural blood patch was performed, leading to an improvement in the headache and abducens nerve palsy...
March 28, 2018: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/29429479/-chronic-post-dural-headache-secondary-to-meningitis
#12
Andreas Ravn, Louise Feldborg Lyckhage, Rigmor Høland Jensen
In this case report a young man was admitted with fever and headache, and a lumbar puncture revealed viral meningitis. After discharge, the patient experienced persistent headache, which worsened, when he was in upright position. The condition was considered secondary to the meningitis. After 14 months, the patient was diagnosed with post-dural puncture headache and treated with an epidural blood patch (EBP). The patient experienced no headache for three months, whereafter it returned. Subsequent EBP's were unsuccessful...
February 5, 2018: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29420792/assessment-of-neurological-toxicity-of-hydroxyethyl-starch-130-0-4-injected-in-the-intrathecal-space-in-rats
#13
O Vassal, P Del Carmine, F-P Desgranges, L Bouvet, M Lilot, N Gadot, Q Timour-Chah, D Chassard
Objective: Epidural blood patch is the procedure of choice to relieve postdural puncture headache. Hydroxyethyl-starch (HES) has been proposed as a patch in some circumstances such as in the case of hematological disease due to the theoretical risk of neoplastic seeding to the central nervous system. Acute neurological HES toxicity has been excluded by a previous animal study, but the long-term neurological toxicity has not been evaluated. Methods: Rats were randomly assigned to one of three groups: no intrathecal injection, 20 μL of intrathecal saline, or a 20-μL intrathecal HES (6% hydroxyethyl starch 130/0...
February 6, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29402441/-ropivacaine-use-in-transnasal-sphenopalatine-ganglion-block-for-post-dural-puncture-headache-in-obstetric-patients-case-series
#14
Inês Furtado, Isabel Flor de Lima, Sérgio Pedro
PURPOSE: Sphenopalatine ganglion block is widely accepted in chronic pain; however it has been underestimated in post dural puncture headache treatment. The ganglion block does not restore normal cerebrospinal fluid dynamics but effectively reduces symptoms associated with resultant hypotension. When correctly applied it may avoid performance of epidural blood patch. The transnasal approach is a simple and minimally invasive technique. In the cases presented, we attempted to perform and report the ganglion block effectiveness and duration, using ropivacaine...
February 2, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29223694/atraumatic-versus-conventional-lumbar-puncture-needles-a-systematic-review-and-meta-analysis
#15
Siddharth Nath, Alex Koziarz, Jetan H Badhiwala, Waleed Alhazzani, Roman Jaeschke, Sunjay Sharma, Laura Banfield, Ashkan Shoamanesh, Sheila Singh, Farshad Nassiri, Wieslaw Oczkowski, Emilie Belley-Côté, Ray Truant, Kesava Reddy, Maureen O Meade, Forough Farrokhyar, Malgorzata M Bala, Fayez Alshamsi, Mette Krag, Itziar Etxeandia-Ikobaltzeta, Regina Kunz, Osamu Nishida, Charles Matouk, Magdy Selim, Andrew Rhodes, Gregory Hawryluk, Saleh A Almenawer
BACKGROUND: Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. METHODS: In this systematic review and meta-analysis, we independently searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomised controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication...
March 24, 2018: Lancet
https://www.readbyqxmd.com/read/29140961/cervical-foraminal-epidural-blood-patch-for-the-targeted-treatment-of-refractory-cerebrospinal-fluid-leakage-from-a-dural-sleeve
#16
Nuj Tontisirin, Pannawit Benjhawaleemas, Sasikaan Nimmaanrat, Pornchai Sathirapanya, Teeranan Laohawiriyakamol, De Q Tran, Roderick J Finlayson
Epidural blood patches (EBPs) are routinely used to treat symptoms (eg, headaches) associated with spontaneous intracranial hypotension. Although cerebrospinal fluid leakage commonly involves the periforaminal areas of the cervical or thoracic spine, EBPs have been historically performed at the lumbar level. Recent evidence suggests that targeting the causative spinal segment may provide greater clinical benefits. While previous reports have targeted foraminal leaks with segmental thoracic or cervical injections, we present a case report detailing the novel use of a navigable epidural catheter to perform a selective EBP at the C7/T1 foramen...
February 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29110769/impaired-cerebrospinal-fluid-pressure
#17
Jan Hoffmann
Abnormalities of cerebrospinal fluid (CSF) pressure are relatively common and may lead to a variety of symptoms, with headache usually being the most prominent one. The clinical presentation of alterations in CSF pressure may vary significantly and show a striking similitude to several primary headache syndromes. While an increase in CSF pressure may be of primary or secondary origin, a pathologic decrease of CSF pressure is usually the result of a meningeal rupture with a resulting leakage of CSF. The pathophysiologic mechanisms of idiopathic intracranial hypertension (IIH) remain largely unknown...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29095711/blood-patch-in-a-jehovah-s-witness-case-report-of-a-novel-arterial-to-epidural-closed-circuit-technique
#18
Kevin R Olsen, Ashley L Screws, Stephen O Vose
Jehovah's Witness patients have unique perioperative challenges involving blood products. We describe the use of a novel method to maintain a closed circuit between a Jehovah's Witness patient's arterial blood and the epidural space while performing a blood patch for postdural puncture headache. Previously described methods have utilized venous catheters to maintain a closed circuit between the body and the epidural space. This is the first report we are aware of that utilizes a closed-circuit arterial blood supply to create an epidural blood patch in a Jehovah's Witness patient...
November 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29052799/treatment-and-outcome-of-subdural-hematoma-in-patients-with-spontaneous-intracranial-hypotension-a-report-of-35-cases
#19
Enrico Ferrante, Fabio Rubino, Federica Beretta, Caroline Regna-Gladin, M Mirko Ferrante
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, low CSF pressure and diffuse pachymeningeal enhancement on brain MRI. SIH results from spontaneous CSF leakage leading to brain sag. Sometimes, tearing of bridging veins may produce subdural hematomas (SDHs). Patients with SDH were identified retrospectively from 212 consecutive SIH patients. Data were collected on demographics, clinical courses, neuroimaging findings, treatment and outcome of SDH. Thirty-five patients (16%), (6 women, 29 men; aged 33-68; mean, 50 years) with SDH were recruited...
October 20, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/28984516/multilevel-ultra-large-volume-epidural-blood-patch-for-the-treatment-of-neurocognitive-decline-associated-with-spontaneous-intracranial-hypotension-case-report
#20
Michael D Staudt, Stephen H Pasternak, Manas Sharma, Sachin K Pandey, Miguel F Arango, David M Pelz, Stephen P Lownie
Spontaneous intracranial hypotension (SIH) is a progressive clinical syndrome characterized by orthostatic headaches, nausea, emesis, and occasionally focal neurological deficits. Rarely, SIH is associated with neurocognitive changes. An epidural blood patch (EBP) is commonly used to treat SIH when conservative measures are inadequate, although some patients require multiple EBP procedures or do not respond at all. Recently, the use of a large-volume (LV) EBP has been described to treat occult leak sites in treatment-refractory SIH...
October 6, 2017: Journal of Neurosurgery
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