Bel Ivan, Moreno Luis-Alfonso, Gomar Carmen
Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínic, Barcelona, Spain.
Can J Anaesth. 2006 Jun;53(6):591-4. doi: 10.1007/BF03021850.
This report describes treatment with epidural dextran-40 and paramethasone injection of postural headache resulting from spontaneous intracranial hypotension in a pregnant patient.
A 39-yr-old pregnant woman consulted the pain clinic for the assessment of a debilitating postural headache which was non-responsive to conventional analgesic treatment. Clinical findings and cranial magnetic resonance imaging indicated the diagnosis of spontaneous intracranial hypotension syndrome. Treatment with an epidural blood patch was not undertaken for several reasons. A lumbar epidural injection with dextran-40 and paramethasone led to a significant improvement in the symptoms and allowed a progressive discontinuation of adjuvant treatment with oral steroids, with complete resolution of symptoms.
We report a case of spontaneous intracranial hypotension in a pregnant patient successfully treated by epidural injection of dextran-40 and paramethasone, with adjuvant oral steroid therapy. Clinical trials are warranted to establish the efficacy of this treatment as an alternative to the epidural blood patch administration.
本报告描述了一名孕妇因自发性颅内低压导致体位性头痛，采用硬膜外注射右旋糖酐-40和曲安西龙治疗的情况。
一名39岁孕妇因顽固性体位性头痛到疼痛门诊就诊，该头痛对常规镇痛治疗无效。临床检查结果及头颅磁共振成像提示自发性颅内低压综合征的诊断。由于多种原因未进行硬膜外血贴治疗。腰椎硬膜外注射右旋糖酐-40和曲安西龙后症状显著改善，可逐渐停用口服类固醇辅助治疗，症状完全缓解。
我们报告了一例孕妇自发性颅内低压患者，通过硬膜外注射右旋糖酐-40和曲安西龙并辅以口服类固醇治疗成功治愈。有必要进行临床试验以确定这种治疗方法作为硬膜外血贴治疗替代方案的疗效。
