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Published on: February 29, 2020
Recurrent Spontaneous Cerebrospinal Fluid Leaks at Multiple Levels.
Sanjeev Kumar Bhoi1, Suprava Naik2, Devendra Gupta3
1Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Multiple spinal cerebrospinal fluid (CSF) leaks can cause intracranial hypotension and recurrent paraplegia. Epidural blood patches (EBP) can treat these rare cases, though complications may occur.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Intracranial hypotension from multiple spinal epidural cerebrospinal fluid (CSF) leaks is uncommon.
- Patients with this condition often require epidural blood patches (EBP) for treatment.
Observation:
- A case of recurrent paraplegia due to intracranial hypotension following multiple spinal epidural CSF leaks at D1, D10, D11, and L2 levels is presented.
- Initial EBP at the thoracic and lumbar regions was followed by paraplegia, necessitating a D1-level EBP, which led to temporary quadriplegia and root pain.
Findings:
- The patient experienced symptom resolution after the D1-level EBP and remained symptom-free for 18 months.
- Nuclear scintigraphy and CT myelography are valuable tools for identifying the location of spinal CSF leaks.
Implications:
- Spinal epidural CSF leak should be considered in patients presenting with low-pressure headaches and recurrent paraplegia.
- This case highlights the potential complications and management of EBP in complex CSF leak scenarios.
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