Epidural blood patch for persistent cerebrospinal fluid leak after epidural catheter removal in an infant

Persistent fluid leakage following epidural catheter removal is rare in infants and may indicate cerebrospinal fluid leakage, with poorly described clinical manifestations. We report a case of a 10-month-old infant who developed persistent fluid leakage from the epidural insertion site and position-dependent changes in consciousness after the removal of a thoracic epidural catheter following right hepatectomy. Brain computed tomography excluded acute intracranial pathology, and the clinical course suggested intracranial hypotension secondary to suspected cerebrospinal fluid leakage. Bed rest, pressure dressings and intravenous fluids were unsuccessful in improving the leakage or the neurological symptoms. An epidural blood patch was performed by injecting 2.5 ml (0.31 ml.kg^-1) of autologous venous blood into the epidural space. No further leakage was observed from the epidural insertion site and the patient's neurological status rapidly returned to baseline. This case highlights the diagnostic challenges of suspected intracranial hypotension in infants and describes the clinical course following the performance of an epidural blood patch.