[Indications for the use of an epidural blood patch in the treatment of spontaneous intracranial hypotension].

We report a patient with spontaneous intracranial hypotension treated with an epidural blood patch (EBP) and discuss the indication of this procedure in the treatment of this syndrome. Once diagnosis has been established (symptoms, CSF pressure, MRI), we propose to wait no more than a week, when simple treatment options have failed, before proceeding to an EBP. We inject a minimum of 20 ml, until the appearance of pain while injecting, of autologous blood in the L3-L4 epidural space. If this technique is unsuccessful, T6 would appear to be the best level to perform an EBP because it is by far the most common location of dural leakage (cervico-dorsal junction) and because this choice is also in accordance with the fact the blood may spread over 10 vertebral segments on each side of the injection level. Spinal MRI should at best be done before the procedure but is absolutely required when the patient fails to respond to the EBP conducted in the conditions we propose.