Treatment of spontaneous intracranial hypotension with continuous epidural saline infusion: A case report

Shiro Kawasaki, Yuji Yamamoto, Norio Sunami, Masakazu Suga, Shinichiro Mizumatsu, Takeshi Inoue

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7 Citations (Scopus)

Abstract

We describe that a 27-year-old woman with a severe postural headache for a month due to spontaneous intracranial hypotension was successfully treated with a continuous epidural saline infusion (CESI). She presented with sudden postural headache and back pain. On admission, CT scans of the head and thoracic spine were normal. Spontaneous intracranial hypotension (SIH) was suspected from her symptoms that her headache was worsen by the erect position and relieved by the supine position. She was treated with intravenous infusion (1000 ml/day), but her headache did not resolve. Three weeks later, MR images showed descent of the brain stem and cerebellar tonsil, effacement of the sulci and cisterns, subdural fluid collections and diffuse meningeal enhancement. A lumbar puncture was performed and yielded an opening CSF pressure of 75 mmH2O in the horizontal position. Radionucleotide cisternography showed early accumulation of nucleotide in the bladder, slow ascent along the spinal axis, less than expected activity over the cerebral convexities and early disappearance of radioactivity. As for the treatment, an epidural catheter was placed at the L 1-2 level and CESI of 15 ml/hour was started. Immediately the postural headache resolved and the next day she could walk. CESI was continued for 5 days. MR images after CESI showed normalization of the sulci and cisterns including spinal subarachnoid space, reelevation of the brain stem and cerebellar tonsil and improvement of meningeal enhancement. She remained headache free during 7 months of follow- up period. We propose this method as a safe and effective treatment for SIH.

Original languageEnglish
Pages (from-to)711-715
Number of pages5
JournalBrain and Nerve
Volume51
Issue number8
Publication statusPublished - Sep 28 1999
Externally publishedYes

Keywords

  • Continuous epidural saline infusion
  • Postural headache
  • RI cisternography
  • Spontaneous intracranial hypotension

ASJC Scopus subject areas

  • Neuroscience(all)

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  • Cite this

    Kawasaki, S., Yamamoto, Y., Sunami, N., Suga, M., Mizumatsu, S., & Inoue, T. (1999). Treatment of spontaneous intracranial hypotension with continuous epidural saline infusion: A case report. Brain and Nerve, 51(8), 711-715.