J Dent Anesth Pain Med.  2018 Aug;18(4):255-259. 10.17245/jdapm.2018.18.4.255.

Epidural blood patch treatment of diplopia that developed after headache resolution in a patient with spontaneous intracranial hypotension

• Lee MS
• Lee S
• Seo DK
• Yoon SH
• Choi SS

• KMID: 2419067
• DOI: http://doi.org/10.17245/jdapm.2018.18.4.255

Abstract

Sudden headache onset may rarely be caused by spontaneous intracranial hypotension (SIH). Other associated symptoms in patients with SIH are nausea, vomiting, vertigo, hearing alteration, and visual disturbance. This case report describes a 43-year-old female diagnosed with SIH who developed diplopia after resolution of an abrupt-onset headache, which was managed with conservative treatments, including bed rest and hydration. She was also diagnosed with secondary right sixth cranial nerve palsy. Although conservative management relieved her headache, the diplopia was not fully relieved. Application of an autologous epidural blood patch successfully relieved her diplopia, even after 14 days from the onset of visual impairment.

Keyword

Abducens Nerve Palsy; Diplopia; Epidural Blood Patch; Spontaneous Intracranial Hypotension

MeSH Terms

Abducens Nerve Diseases
Adult
Bed Rest
Blood Patch, Epidural*
Diplopia*
Female
Headache*
Hearing
Humans
Intracranial Hypotension*
Nausea
Vertigo
Vision Disorders
Vomiting

Figure

• 

  Fig. 1 Axial (A) and sagittal (B) T1-weighted magnetic resonance imaging without contrast enhancement before EBP showed diffuse pachymeningeal enhancement with thickening (arrow) and venous sinus engorgement.

• 

  Fig. 2 Radionuclide cisternography showed multiple CSF leakages in mid to lower thoracic spine levels, especially T9 and T10 levels at 0.5, 2, 4, and 6 hrs after Tc-99m diethylenetriamine pentaacetic acid (DTPA) injection into the epidural space. POST, posterior.

• 

  Fig. 3 Axial (A) and sagittal (B) T1-weighted magnetic resonance imaging with contrast enhancement after EBP showed decreased extent of diffuse pachymeningeal enhancement with thickening and venous sinus engorgement (white arrow). A small subacute subdural hematoma (red arrow) was observed, although it was not considered clinically significant.

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