Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.388
Peer-review started: September 7, 2021
First decision: September 29, 2021
Revised: October 23, 2021
Accepted: November 22, 2021
Article in press: November 22, 2021
Published online: January 7, 2022
Cerebrospinal fluid (CSF) leakage at C1/2 in spontaneous intracranial hypo
A 60-year-old man with no history of trauma was admitted to our hospital with orthostatic headache, nausea, and vomiting. Brain computed tomography imaging revealed bilateral, subacute to chronic SDH. Brain magnetic resonance imaging (MRI) findings were SDH with dural enhancement in the bilateral cerebral convexity and posterior fossa and mild sagging, suggesting SIH. Although the patient underwent burr hole trephination, the patient’s orthostatic headache was aggravated. MR myelography led to a suspicion of CSF leakage at C1/2. Therefore, we performed a targeted cervical EBP using an epidural catheter under fluoroscopic guidance. At 5 d after EBP, a follow-up MR myelography revealed a decrease in the interval size of the CSF collected. Although his symptoms improved, the patient still complained of headaches; therefore, we repeated the targeted cervical EBP 6 d after the initial EBP. Subsequently, his headache had almost disappeared on the 8th day after the repeated EBP.
Targeted EBP is an effective treatment for SDH in patients with SIH due to CSF leakage at C1/2.
Core Tip: Cerebrospinal fluid (CSF) leakage at C1/2 in spontaneous intracranial hypotension (SIH) is rare. Subdural hematoma (SDH), a serious complication of SIH, may lead to neurological deficits. After a repeated targeted cervical epidural blood patch using an epidural catheter under fluoroscopic guidance, the patient’s symptoms had almost disappeared, and a magnetic resonance myelography revealed a decrease in the interval size of the CSF collected. This case highlights the efficacy of the delivery of autologous blood via an epidural catheter inserted into the lower cervical spine as a treatment for SDH in patients with SIH due to CSF leakage at C1/2.