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Epidural blood patch for cerebrospinal fluid leak-induced subdural hematoma in a pediatric patient: illustrative case
Ryan S Chung1,2,3, Lacin Koro1,2, Benjamin Best1
1Division of Pediatric Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Epidural blood patch (EBP) effectively treated intracranial hypotension (IH) and subdural hematomas (SDH) in a pediatric patient, highlighting EBP as a safe intervention for these serious conditions.
Area of Science:
- Neurology
- Pediatric Medicine
- Neurosurgery
Background:
- Intracranial hypotension (IH) can cause serious complications like subdural hematomas (SDH).
- Spontaneous or iatrogenic cerebrospinal fluid (CSF) leaks are common causes of IH.
- Epidural blood patch (EBP) is a known treatment for IH, but its use in pediatric patients with SDH is not well-documented.
Purpose of the Study:
- To report the successful use of EBP as a solitary intervention for IH with SDH in a pediatric patient.
- To emphasize the importance of considering IH in pediatric patients with specific headache presentations.
- To highlight the potential of EBP in preventing further complications.
Main Methods:
- A case study of an 11-year-old male with acute myeloid leukemia who developed IH and SDH after a lumbar puncture.
- Initial diagnosis included imaging for SDH and MRI of the lumbar spine to identify a CSF leak.
- Treatment involved an EBP after conservative management failed.
Main Results:
- The patient experienced immediate headache relief following the EBP.
- Radiographic evidence confirmed the resolution of the SDH.
- The EBP was effective despite an initially inconclusive MRI for CSF leak.
Conclusions:
- High suspicion for IH is crucial in pediatric patients presenting with postural headaches post-lumbar puncture, even with non-diagnostic imaging.
- EBP can be a safe and effective treatment for pediatric patients with IH and SDH.
- Prompt intervention with EBP may prevent clinical deterioration and further complications in this population.
Background:
Intracranial hypotension (IH) is a secondary headache syndrome that can result from spontaneous or iatrogenic CSF leaks. Subdural hematomas (SDHs) are a particularly dangerous sequela of IH. Although epidural blood patch (EBP) is a recognized treatment for IH, its use in pediatric patients with SDH as a solitary intervention has not been reported.
Observations:
An 11-year-old male with newly diagnosed acute myeloid leukemia developed persistent, postural headaches following a lumbar puncture performed for diagnostic and therapeutic purposes. Initial imaging revealed a moderate left-sided SDH with midline shift, yet MRI of the lumbar spine failed to demonstrate an obvious CSF leak. Conservative management did not alleviate symptoms. Given the clinical picture of low CSF pressure, an EBP was administered, resulting in immediate headache improvement and subsequent radiographic evidence of SDH resolution.
Lessons:
This case underscores the importance of maintaining a high index of suspicion for IH in pediatric patients with postural headaches after lumbar puncture, even when imaging is inconclusive. EBP can be a safe and effective intervention, potentially preventing further complications and clinical deterioration in this vulnerable population. https://thejns.org/doi/10.3171/CASE25254.
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