Jane MacDonald <jmacdonald at mta.ca> writes:
>I would appreciate ANY information on Spontaneous Intracerebral Hypotension -
>articles to look up, case histories, other sources of info., ANy information.
No mention is made whether the patient had a myelogram or a spinal tap. If she
did, then that is the likely cause of the intracranial hypotension.
If the leak is from the lower spine, then she would benefit greatly
from an epidural blood patch. It is a technique done by anesthesiologists
and usually gives instantaneous relief. The technique is low risk and low
cost.
The other possible place for a leak is through the nose or ear secondary
to trauma. Most people would be able to see the spinal fluid coming out
of the ear or mouth, though.
I believe a MR is a reasonable starting point for diagnostic purposes. If it
is positive you will have your answer. If it is negative it may be reasonable
to proceed with an epidural blood patch anyway on the assumption that the leak
is too small to see on MR. Other tests, such as lumbar puncture or radionuclide
study would be associated with possible exacerbation of her intracranial
hypotension, compounding her problem, necessitating the same blood patch
that would be necessary anyway. Good luck.
J. Segal
