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• Vol.45 No.9
• CLINICA NEUROL, 45: 679−681, 2005
• Vol.45 No.9 contents

Brief Clinical Note

A case of spontaneous intracranial hypotension with multiple CSF leaks in the thoracic region

Motomi Arai, M.D., Ph.D.¹⁾ and Tomosue Takada, M.D.²⁾

Departments of ¹⁾Neurology and ²⁾Anesthesiology, Seirei Mikatahara General Hospital

A case of spontaneous intracranial hypotension (SIH) with multiple cerebrospinal fluid (CSF) leaks is reported. A 54-year-old man experienced a severe generalized headache associated with nausea and decreased hearing. The headache appeared when he was sitting or standing but was completely relieved by lying down. Cranial MRI with gadolinium infusion showed diffuse pachymeningeal enhancement. Spinal MRI demonstrated small amount of epidural fluid collection in the upper thoracic region. Radionuclide cisternography demonstrated CSF leaks at the Th2 and Th7 levels on the left side and at the Th3 through Th5 levels on the right side. Since bed-rest and intravenous transfusion for 10 days showed no beneficial effects, epidural blood patch (EBP) at the Th6/7 interspace was performed. After receiving EBP four times repeatedly, his symptoms entirely disappeared.
SIH patients with multiple CSF leaks are rare in the literature. Although no consensus exists on the treatment strategy for such cases, our case suggests that at least 2 EBPs should be performed for each leak site before considering surgical treatment.

(CLINICA NEUROL, 45: 679−681, 2005)
key words: spontaneous intracranial hypotension, cerebrospinal fluid leak, epidural blood patch

(Received: 26-Feb-05)