Epidural Blood Patch for Spontaneous Intracranial Hypotension

Abstract

Background: Spontaneous intracranial hypotension (SIH) is uncommon and postulated to occur due to spontaneous cerebrospinal fluid (CSF) leak. Subdural hemorrhage is a rare but serious complication of intracranial hypotension. With a paucity of high-level evidence to guide treatment, its management remains challenging. Case presentation: We report a case of spontaneous intracranial hypotension which was successfully treated with an epidural blood patch. The patient is a 59-year-old man with poorly controlled diabetes and hyperlipidemia who presented with left trochlear nerve palsy and bilateral acute subdural haemorrhage (SDH) secondary to SIH. He underwent bilateral burr hole drainage of acute SDH under general anaesthesia. Post-extubation, an epidural blood patch was performed which resulted in resolution of his symptoms. Conclusion: We highlight an interesting case of SIH presenting atypically with cranial nerve IV palsy and its successful management with epidural blood patch.