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Cerebrospinal Fluid01:21

Cerebrospinal Fluid

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Cerebrospinal fluid (CSF) is a colorless liquid that flows around the brain and the spinal cord, playing a vital role in the protection, support, and overall function of the central nervous system (CNS). CSF production, circulation, and absorption are tightly regulated processes essential for the brain and spinal cord to function properly.
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A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial...
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Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
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Occult spinal CSF leak: to patch or not to patch-a case-based update.

Jiashu Wang1, Amine P Thomé2, Allan L Brook3

  • 1Albert Einstein College of Medicine, Bronx, NY, USA. jiashu.wang@einsteinmed.edu.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|December 21, 2025
PubMed
Summary
This summary is machine-generated.

Occult spontaneous intracranial hypotension (oSIH) in children, presenting with normal imaging, can be successfully treated with an empiric epidural blood patch (EBP). This approach offers significant symptom relief when conservative measures fail.

Keywords:
Case reportCerebrospinal fluid leakEpidural blood patchPediatricSpontaneous intracranial hypotension

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Area of Science:

  • Neurology
  • Pediatrics
  • Neurosurgery

Background:

  • Spontaneous intracranial hypotension (SIH) is rare in children, characterized by orthostatic headaches due to cerebrospinal fluid (CSF) leaks.
  • Normal brain and spine imaging in suspected SIH is uncommon, leading to diagnostic challenges.
  • Occult SIH (oSIH) in adults is treated with empiric epidural blood patches (EBPs), but pediatric use is unreported.

Purpose of the Study:

  • To report the first pediatric case of clinically suspected occult SIH with normal imaging.
  • To evaluate the efficacy of empiric epidural blood patch (EBP) in a pediatric patient with occult SIH.
  • To highlight empiric EBP as a potential treatment for pediatric oSIH when conservative therapies fail.

Main Methods:

  • Case report of a 9-year-old girl with severe orthostatic headaches and normal brain/spine MRIs.
  • Literature review of SIH and oSIH cases treated with empiric EBP using PubMed.
  • Management included diagnosis of oSIH and subsequent empiric lumbar EBP.

Main Results:

  • The patient presented with classic SIH symptoms but had no abnormalities on multiple MRIs.
  • Previous treatments for suspected post-viral syndrome and migraines provided minimal relief.
  • Empiric lumbar EBP resulted in profound, complete, and sustained symptom resolution.

Conclusions:

  • Empiric epidural blood patch (EBP) is a viable and effective treatment for pediatric occult SIH (oSIH).
  • In cases of high clinical suspicion for pediatric oSIH despite normal imaging, empiric EBPs should be considered.
  • Empiric EBP offers a low procedural risk and significant symptomatic improvement for pediatric oSIH.