Epidural Blood Patch in Spontaneous Intracranial Hypotension and Role of Optic Nerve Sheath Diameter: A Case Report

Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF) and it is characterized by an orthostatic headache without a history of trauma or dural puncture. Patients may present with headache, there may be low CSF pressure, or imaging evidence of CSF leak. Epidural blood patching (EBP) has been considered as the mainstay of therapy for SIH. We report a case of SIH with bilateral subdural hematoma in a 63-year-old female patient who presented with sudden-onset headache for 4 days without any history of loss of consciousness, vomiting, or seizures. Lumbar EBP was given and it resulted in improved clinical features, imaging findings, and increase in optic nerve sheath diameter (ONSD) when compared with ONSD before EBP administration. EBP produces a tamponade effect and its efficacy results from sealing the dural defect by the injected blood, thus stopping the CSF leak.