Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Lombardia, Italy.
Neurosurgery, University of Rome La Sapienza, Rome, Lazio, Italy.
BMJ Case Rep. 2024 Mar 15;17(3):e257743. doi: 10.1136/bcr-2023-257743.
Spontaneous intracranial hypotension (SIH) is a condition characterised by postural headaches due to low cerebrospinal fluid (CSF) pressure, often stemming from CSF leakage. Diagnosis poses a significant challenge, and the therapeutic approach encompasses both conservative measures and operative interventions, such as the epidural blood patch (EBP). However, EBP carries the potential risk of inducing rebound intracranial hypertension (RIH), subsequently leading to high-pressure headaches. We present a case wherein RIH following EBP was effectively managed through the implementation of an external ventricular drain (EVD) aimed at reducing CSF pressure. The patient improved significantly, underscoring the potential utility, if not necessity, of EVD in carefully selected cases, highlighting the imperative for further research to enhance the management of SIH and optimise EBP-related complications.
自发性颅内低血压(SIH)是一种以体位性头痛为特征的病症,其发生原因是脑脊液(CSF)压力降低,通常源于 CSF 泄漏。诊断具有挑战性,治疗方法包括保守治疗和手术干预,如硬膜外血贴(EBP)。然而,EBP 存在诱发颅内压反跳性升高(RIH)的风险,进而导致高压性头痛。我们报告了一例 EBP 后出现 RIH 的病例,通过实施外部脑室引流(EVD)降低 CSF 压力,成功管理了 RIH。患者显著改善,提示 EVD 在仔细选择的病例中具有潜在的应用价值,如果不是必要的话,突显了进一步研究以改善 SIH 管理和优化 EBP 相关并发症的必要性。