Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Neurol India. 2021 Nov-Dec;69(6):1828-1830. doi: 10.4103/0028-3886.333501.
Intracranial hypotension due to multiple spinal epidural cerebrospinal fluid (CSF) leak is rare and has multiple etiologies. These patients require epidural blood patches (EBP). We report a patient with recurrent paraplegia due to intracranial hypotension following recurrent epidural CSF leak. Cerebrospinal fluid leak was noted at D1, D10, D11, and L2 levels. Autologous epidural blood patch (EBP) at lower thoracic (3 ml) and lumbar region (4 ml) was performed. The patient developed paraplegia with sensory level at D2 for which 3 ml of EBP was done at D1 level after two months. Following EBP, the patient developed quadriplegia and root pain, which recovered in one month. The patient was free of symptoms for 18 months. Spinal epidural CSF leak should be suspected in patients with features of low pressure headache and recurrent paraplegia at multiple levels. Nuclear scintigraphy and CT myelography help in localizing the site of leak.
颅内低血压是由多个硬脊膜外脑脊液（CSF）漏引起的，其病因多种多样。这些患者需要硬膜外血贴（EBP）治疗。我们报告了一例颅内低血压导致的复发性截瘫患者，该患者在复发性硬脊膜外 CSF 漏后出现颅内低血压。CSF 漏发生在 D1、D10、D11 和 L2 水平。在胸段（3ml）和腰段（4ml）进行了自体硬膜外血贴（EBP）。两个月后，患者出现 D2 感觉水平的截瘫，在 D1 水平进行了 3ml 的 EBP。EBP 后，患者出现四肢瘫痪和神经根痛，一个月后恢复。患者 18 个月无症状。对于有低血压头痛和多个水平复发性截瘫特征的患者，应怀疑为脊髓硬膜外 CSF 漏。核闪烁扫描和 CT 脊髓造影有助于确定漏口的位置。
