Korean J Pain.  2012 Apr;25(2):112-115. 10.3344/kjp.2012.25.2.112.

Epidural Blood Patch for the Treatment of Abducens Nerve Palsy due to Spontaneous Intracranial Hypotension: A Case Report

• Kim YA
• Yoon DM
• Yoon KB

• KMID: 1778996
• DOI: http://doi.org/10.3344/kjp.2012.25.2.112

Abstract

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.

Keyword

abducens nerve palsy; epidural blood patch; spontaneous intracranial hypotension

MeSH Terms

Abducens Nerve
Abducens Nerve Diseases
Blood Patch, Epidural
Headache
Intracranial Hypotension
Paralysis
Post-Dural Puncture Headache
Supine Position

Figure

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  Fig. 1 Right sixth cranial nerve palsy (arrow): Looking forward (A), gazing to the right (B), and gazing to the left (C), and 1 month later after EBP, gazing to the right (D).

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  Fig. 2 Brain MRI shows diffuse pachymeningeal thickening and enhancement (A). CT myelogram shows contrast leakage in the posterior epidural space, black arrow in the magnified inset indicates CSF leakage (B).

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  Fig. 3 Cervical epidurography for EBP.

Reference

1. Schievink WI, Dodick DW, Mokri B, Silberstein S, Bousser MG, Goadsby PJ. Diagnostic criteria for headache due to spontaneous intracranial hypotension: a perspective. Headache. 2011; 51:1442–1444. PMID: 21658029.

2. Schwedt TJ, Dodick DW. Spontaneous intracranial hypotension. Curr Pain Headache Rep. 2007; 11:56–61. PMID: 17214923.

3. Zada G, Solomon TC, Giannotta SL. A review of ocular manifestations in intracranial hypotension. Neurosurg Focus. 2007; 23:E8. PMID: 18004970.

4. Nishio I, Williams BA, Williams JP. Diplopia: a complication of dural puncture. Anesthesiology. 2004; 100:158–164. PMID: 14695737.

5. Koeppen AH. Abducens palsy after lumbar puncture. Proc Wkly Semin Neurol. 1967; 17:68–76. PMID: 4907858.

6. Schober P, Loer SA, Schwarte LA. Paresis of cranial nerve VI (N. abducens) after thoracic dural perforation. Minerva Anestesiol. 2010; 76:1085–1087. PMID: 20838373.

7. Béchard P, Perron G, Larochelle D, Lacroix M, Labourdette A, Dolbec P. Case report: epidural blood patch in the treatment of abducens palsy after a dural puncture. Can J Anaesth. 2007; 54:146–150. PMID: 17272255.

8. Kim KS, Lee DI, Kang WJ, Shin OY, Kwon MI. A case of cervical epidural blood patch for treatment of spontaneous intracranial hypotension. J Korean Pain Soc. 2002; 15:198–203.