Chung Ryan S, Koro Lacin, Best Benjamin, Desai Virendra R
Division of Pediatric Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California.
Department of Neurological Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
J Neurosurg Case Lessons. 2025 Sep 8;10(10). doi: 10.3171/CASE25254.
Intracranial hypotension (IH) is a secondary headache syndrome that can result from spontaneous or iatrogenic CSF leaks. Subdural hematomas (SDHs) are a particularly dangerous sequela of IH. Although epidural blood patch (EBP) is a recognized treatment for IH, its use in pediatric patients with SDH as a solitary intervention has not been reported.
An 11-year-old male with newly diagnosed acute myeloid leukemia developed persistent, postural headaches following a lumbar puncture performed for diagnostic and therapeutic purposes. Initial imaging revealed a moderate left-sided SDH with midline shift, yet MRI of the lumbar spine failed to demonstrate an obvious CSF leak. Conservative management did not alleviate symptoms. Given the clinical picture of low CSF pressure, an EBP was administered, resulting in immediate headache improvement and subsequent radiographic evidence of SDH resolution.
This case underscores the importance of maintaining a high index of suspicion for IH in pediatric patients with postural headaches after lumbar puncture, even when imaging is inconclusive. EBP can be a safe and effective intervention, potentially preventing further complications and clinical deterioration in this vulnerable population. https://thejns.org/doi/10.3171/CASE25254.
颅内低压（IH）是一种继发性头痛综合征，可由自发性或医源性脑脊液漏引起。硬膜下血肿（SDH）是IH的一种特别危险的后遗症。尽管硬膜外血贴（EBP）是公认的治疗IH的方法，但其在患有SDH的儿科患者中作为单一干预措施的应用尚未见报道。
一名11岁新诊断为急性髓系白血病的男性患者，在进行诊断和治疗性腰椎穿刺后出现持续性体位性头痛。初始影像学检查显示左侧中度SDH伴中线移位，但腰椎MRI未显示明显的脑脊液漏。保守治疗未能缓解症状。鉴于脑脊液压力低的临床表现，给予了EBP，头痛立即改善，随后有影像学证据表明SDH消退。
该病例强调，对于腰椎穿刺后出现体位性头痛的儿科患者，即使影像学检查结果不明确，也应高度怀疑IH。EBP可能是一种安全有效的干预措施，有可能预防这一脆弱人群的进一步并发症和临床恶化。https://thejns.org/doi/10.3171/CASE25254
