Villani Linda A, Digre Kathleen B, Cortez Melissa M, Bokat Christina, Rassner Ulrich A, Ozudogru Seniha N
Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
Division of Headache and Neuro-Ophthalmology, University of Utah School of Medicine, Salt Lake City, UT, USA.
Headache. 2021 Feb;61(2):244-252. doi: 10.1111/head.14076. Epub 2021 Feb 13.
To report a case of arachnoiditis as a complication of epidural blood patch procedures and to systematically review the diagnostic workup, clinical outcomes, and treatment modalities reported in the literature.
Epidural blood patching is an effective treatment for low-pressure headache secondary to spontaneous cerebrospinal fluid leak or iatrogenic post-dural puncture. Spontaneous intracranial hypotension is believed to be a rare headache disorder, but recently has been diagnosed at higher frequencies, making it an important differential diagnosis for intractable headaches. Arachnoiditis has surfaced as a rare complication of epidural blood patching. Symptom presentation does not always correlate with evidence of meningeal enhancement on imaging. Optimal methods for treatment remain largely unknown.
Databases Embase and PubMed were searched for all published studies on arachnoiditis post-epidural blood patch using a combination of the following medical subject headings and keywords: arachnoiditis, arachnoid inflammation, adverse event, and epidural blood patch. All original English-language articles that described arachnoid and/or meningeal inflammation in conjunction with epidural blood patch procedures were included for analysis. Title and abstract screening, data extraction, and risk of bias assessment were conducted independently and in duplicate by two reviewers.
Seven other cases of arachnoiditis post-blood patch placement have been documented, most of which were diagnosed via magnetic resonance imaging. Six of these were a result of a spinal-epidural anesthesia for labor and delivery. Common symptoms reported were headache, back and radicular pain, paresthesia, and motor weakness. There are currently no proven consensus-based treatment recommendations available. While intravenous methylprednisolone followed by oral prednisone taper was found to be effective in the case presented, the benefit of other multi-modal therapies was unclear.
Headache specialists who treat postural headache should be aware of arachnoiditis as a potentially severe complication of epidural blood patch. The case presented is the first of its kind to report arachnoiditis as a complication of high-volume blood patch for the treatment of spontaneous intracranial hypotension. More studies are required to determine suitable treatment options for post-epidural blood patch arachnoiditis.
报告1例蛛网膜膜炎作为硬膜外血贴术并发症的病例，并系统回顾文献中报道的诊断检查、临床结局及治疗方式。
硬膜外血贴术是治疗自发性脑脊液漏或医源性硬膜穿刺后所致低压性头痛的有效方法。自发性颅内低压被认为是一种罕见的头痛性疾病，但近年来诊断频率有所升高，使其成为难治性头痛的重要鉴别诊断。蛛网膜膜炎已成为硬膜外血贴术的一种罕见并发症。症状表现并不总是与影像学上脑膜强化的证据相关。最佳治疗方法在很大程度上仍不明确。
使用以下医学主题词和关键词组合在Embase和PubMed数据库中检索所有已发表的关于硬膜外血贴术后蛛网膜膜炎的研究：蛛网膜膜炎、蛛网膜炎症、不良事件和硬膜外血贴。纳入所有描述与硬膜外血贴术相关的蛛网膜和/或脑膜炎症的英文原文进行分析。由两名 reviewers 独立且重复地进行标题和摘要筛选、数据提取以及偏倚风险评估。
文献记载了另外7例血贴放置后发生蛛网膜膜炎的病例，其中大多数通过磁共振成像诊断。这些病例中有6例是因分娩时脊髓硬膜外麻醉所致。报告的常见症状有头痛、背部和神经根性疼痛、感觉异常及运动无力。目前尚无基于共识的经证实的治疗建议。虽然在本病例中发现静脉注射甲泼尼龙随后逐渐减量口服泼尼松有效，但其他多模式治疗的益处尚不清楚。
治疗体位性头痛的头痛专科医生应意识到蛛网膜膜炎是硬膜外血贴术的一种潜在严重并发症。本病例是首例报告蛛网膜膜炎作为大容量血贴治疗自发性颅内低压并发症的病例。需要更多研究来确定硬膜外血贴术后蛛网膜膜炎的合适治疗方案。
