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A difficult case
Epidural blood patching in an anticoagulated patient with intracranial hypotension
  1. Gabriela Petersen1,2,
  2. Mónica Edith Salmerón-Mercado2,
  3. Karla Madrigal-Rentería2,
  4. Alexandra Díaz-Alba1,2,
  5. Víctor García-Navarro1,2
  1. 1ITESM Campus Guadalajara, Zapopan, Jalisco, Mexico
  2. 2Instituto Neurológico de Guadalajara, Zapopan, Mexico
  1. Correspondence to Dr Víctor García-Navarro, ITESM Campus Guadalajara, Zapopan, Jalisco, Mexico; garcianavarrov{at}tec.mx

Abstract

A middle-aged man had classical clinical and radiographical features of spontaneous intracranial hypotension, refractory to conservative management. His medical history included antiphospholipid syndrome, autoimmune thrombocytopenia and recurrent thrombotic events. To reduce his risk from epidural blood patching, we stopped his anticoagulation, but he developed thrombosis. Despite therapeutic challenges, we performed a fluoroscopically guided epidural blood patch successfully at multiple levels, with significant symptom and radiological improvement maintained at 9 months. We review the place of epidural blood patching in people with spontaneous intracranial hypotension who either take anticoagulants or have coexisting blood disorders.

  • HEADACHE
  • PAIN
  • RHEUMATOLOGY
  • SLE
  • HAEMATOLOGY

Data availability statement

Data sharing not applicable as no were datasets generated and/or analysed for this study.

https://doi.org/10.1136/pn-2024-004218

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    Data availability statement

    Data sharing not applicable as no were datasets generated and/or analysed for this study.

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    Footnotes

    • X @gabypeof

    • Contributors GP: conducted data collection and analysis and wrote the initial draft of the manuscript. VG-N: contributed to the conceptualisation of this work, provided critical input on study design and methodology, contributed to data analysis and interpretation, revised the manuscript for intellectual content, approved the final version for submission and is the guarantor. MES-M: participated in data collection and contributed to revision of the manuscript. KM-R: provided expertise in a specific area of the research and critically reviewed the manuscript for important intellectual content. AD-A: provided feedback on manuscript drafts and approved the final version for submission. All authors have read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Fayyaz Ahmed, Hull, UK.

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