Repeated large-volume epidural blood patches for the treatment of spontaneous intracranial hypotension

Refractory headache from spontaneous intracranial hypotension can be debilitating for patients. This report describes the use of repeated high-volume epidural blood patches to treat this condition. A 39-yr-old male presented with a history and diagnostic imaging findings consistent with spontaneous intracranial hypotension. The associated intractable and incapacitating headache was unrelieved by meperidine and a 20 mL lumbar autologous blood patch. Two weeks later, a second epidural blood patch of 45 mL autologous blood administered in the lower thoracic epidural space achieved partial relief. With symptoms persisting despite oral analgesics, a third blood patch was undertaken one month after the initial procedure. On this occasion, administration of 32 mL autologous blood into the mid-thoracic epidural space resulted in complete and lasting resolution of the headache. The ideal volume of blood injectate to achieve maximal effectiveness for an epidural blood patch is unknown. While many clinicians use a predetermined maximal volume, a volume titrated to patient symptoms is a suggested alternate approach.