1
|
Nonaka M, Inomata S. Management of Labor and Anesthesia in a Patient With a History of Spontaneous Intracranial Hypotension: A Case Report With Literature Review. Cureus 2024; 16:e52254. [PMID: 38352098 PMCID: PMC10863527 DOI: 10.7759/cureus.52254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a rare disorder characterized by continuous or intermittent cerebrospinal fluid (CSF) leakage from the CSF cavity, which causes symptoms such as headache or neck pain upon standing. However, no well-established measures concerning the type of delivery and anesthesia for pregnant women with a history of SIH have been reported. A woman had developed SIH 9 years earlier from lifting luggage into an overhead bin with stretching movements, which required continuous saline epidural infusion for recovery. Upon the patient's pregnancy at the age of 35 years, although an elective cesarean section (CS) under general anesthesia was planned to avoid SIH recurrence, the patient had an emergency CS at 36 weeks. Since there is no prescribed method of delivery and anesthetic management for patients with a history of SIH, it is important to plan and adapt a treatment strategy based on the patient's wishes and the institution's protocols. As a sidenote, we reviewed the available literature regarding the type of delivery and anesthesia for pregnant women with a history of SIH.
Collapse
Affiliation(s)
- Mayuko Nonaka
- Department of Anesthesiology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Shinichi Inomata
- Department of Anesthesiology, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| |
Collapse
|
2
|
Rohatgi VK, Robbins MS, Roytman M, Chazen JL. Spontaneous Intracranial Hypotension in Pregnancy. Curr Pain Headache Rep 2023; 27:685-693. [PMID: 37688759 DOI: 10.1007/s11916-023-01163-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE OF REVIEW Spontaneous intracranial hypotension (SIH) is a debilitating disease typically featuring orthostatic headache and caused by a spinal CSF leak. This review will describe the characteristics of SIH in pregnant patients and the associated unique management and treatment considerations. RECENT FINDINGS Herein, a novel case is reported of a 41-year-old woman who presented with SIH pre-conception but saw marked improvement of symptoms after 5 weeks antepartum and symptom recurrence 2 months post-partum. A literature review of SIH in pregnancy revealed 14 reported patients across 10 studies since 2000. All the reported cases resulted in delivery of healthy infants and symptomatic improvement with conservative management or a variety of treatment modalities including non-targeted epidural blood patch (EBP). Clinical and imaging features of SIH in pregnancy are reviewed. We hypothesize an antenatal protective mechanism against SIH symptoms through cephalad redistribution of CSF volume from the spinal to intracranial compartments related to uterine growth and decreased CSF volume within the lumbar cistern. Treatment recommendations are discussed including duration of bed rest and decision for non-targeted multi-site EBPs. When required, non-invasive diagnostic spine MRI using fat-suppressed axial T2-weighted imaging may be helpful.
Collapse
Affiliation(s)
- Varun K Rohatgi
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Michelle Roytman
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Levi Chazen
- Department of Radiology, Hospital for Special Surgery, 535 E 70th St., New York, NY, 10021, USA.
| |
Collapse
|
3
|
Hsu CM, Liu YC, Chen YC, Fuh JL, Huang HC, Wang YF, Chiang IY, Wen YR. Efficacy and safety of cervicothoracic epidural blood patch for patients with spontaneous intracranial hypotension. Pain Pract 2022; 22:586-591. [PMID: 35585760 DOI: 10.1111/papr.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidural blood patch (EBP) is a generally effective treatment for spontaneous intracranial hypotension (SIH) caused by cerebrospinal fluid (CSF) leakage through the spinal dura mater. It is still unclear, however, whether application near the leakage site (targeted EBP) is more effective than distal application (untargeted EBP). Further, EBP targeted to high thoracic or cervical spine levels is infrequent due to greater technical requirements and potential complications. Here we examined the safety and efficacy of EBP applied to high thoracic or cervical spine levels. METHODS We retrospectively reviewed the clinical and outcome data of 13 patients receiving cervical or high thoracic EBP for SIH. All patients were referred by neurologists following poor response to conservative treatment and presented with persistent headache aggravated by orthostatic changes. RESULTS Neuroimaging confirmed CSF leakage, and targeted EBP resulted in immediate pain improvement. Repeated injections provided additional improvement for patients with recurrent headache. No serious adverse events were documented during follow-up. CONCLUSION Based on recent studies and our clinical experience, we conclude that EBP targeted to the high thoracic and cervical spine is safe and effective for early-stage SIH.
Collapse
Affiliation(s)
- Chieh-Min Hsu
- Pain Management and Research Center, Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Cheng Liu
- Pain Management and Research Center, Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Ying-Chu Chen
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hui-Chun Huang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Feng Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - I-Ying Chiang
- Pain Management and Research Center, Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Yeong-Ray Wen
- Pain Management and Research Center, Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan.,Department of Anesthesiology, School of Medicine, China Medical University, Taichung, Taiwan.,Center for Regional Anesthesia and Pain Medicine (CRAPM) of Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
4
|
Ferrante E, Trimboli M, Petrecca G, Allegrini F, Ferrante MM, Rubino F. Management of Spontaneous Intracranial Hypotension During Pregnancy: A Case Series. Headache 2020; 60:1777-1787. [DOI: 10.1111/head.13942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Enrico Ferrante
- Neurology Department AOR San Carlo Potenza Italy
- Neurology Department Alto Vicentino Hospital – AULSS 7 Pedemontana Santorso Italy
| | - Michele Trimboli
- Neurology Department AOR San Carlo Potenza Italy
- Department of Medical and Surgical Sciences Institute of Neurology AOU Mater Domini – Magna Græcia University Catanzaro Italy
| | - Giuseppe Petrecca
- Anesthesiology and Intensive Care Department AOR San Carlo Potenza Italy
| | | | | | - Fabio Rubino
- Palliative Care and Pain Management Department ASST Valtellina Sondrio Italy
| |
Collapse
|
5
|
Grange J, Lorre G, Ducarme G. Iterative epidural blood patch for recurrent spontaneous intracranial hypotension during pregnancy. J Clin Anesth 2016; 34:239-43. [PMID: 27687382 DOI: 10.1016/j.jclinane.2016.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 10/21/2022]
Abstract
A 30-year-old woman at 28 weeks presented with sudden onset of intense headache, epigastric pain, hot flushes, nausea, vomiting, and stiff neck. Cerebral magnetic resonance imaging showed pathognonomic signs of spontaneous intracranial hypotension (SIH). Epidural blood patch was performed 2 times during pregnancy for symptoms relief in spite of medical treatments. No other recurrence was noted until the spontaneous delivery. SIH is a rare entity during pregnancy which may be diagnosed using magnetic resonance imaging. Iterative Epidural blood patch should be proposed to patients with SIH during pregnancy because it allowed faster symptoms improvement and patient relief with complete recovery than medical treatment only.
Collapse
Affiliation(s)
- Joséphine Grange
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Gilbert Lorre
- Department of Anesthesiology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France.
| |
Collapse
|
6
|
Wight JM, Kalidindi R. Management of post-dural puncture headache in late pregnancy before the onset of labour. Int J Obstet Anesth 2015; 25:92-3. [PMID: 26357932 DOI: 10.1016/j.ijoa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J M Wight
- Department of Anaesthetics Medway Maritime Hospital Gillingham, Kent, UK.
| | - R Kalidindi
- Department of Anaesthetics Medway Maritime Hospital Gillingham, Kent, UK
| |
Collapse
|
7
|
McGrath E, Monaghan TS, Alexander M, Hennessy MJ. Recurrent spontaneous intracranial hypotension in early pregnancy. BMJ Case Rep 2010; 2010:2010/oct27_1/bcr0520103040. [PMID: 22791729 DOI: 10.1136/bcr.05.2010.3040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous intracranial hypotension (SIH) is an uncommon condition characterised by postural headache secondary to low cerebrospinal fluid pressure. Here we present a case of recurrence of SIH in early pregnancy in a 26-year-old woman. She first presented at the age of 21 years at 15 weeks' gestation with a history of headache, nausea, vomiting, neck stiffness and photophobia. Findings from a MRI brain scan led to a diagnosis of SIH. She was treated with autologous epidural blood patching and remained asymptomatic until her second pregnancy 5 years later, when she re-presented at 16 weeks' gestation with similar symptoms. She was again diagnosed with SIH and required a repeat treatment of autologous epidural blood patching. She subsequently remained symptom free and delivered a healthy boy at term.
Collapse
Affiliation(s)
- Emer McGrath
- Department of Neurology, University College Hospital, Galway, Ireland.
| | | | | | | |
Collapse
|