A CASE OF SEVERE REBOUND INTRACRANIAL HYPERTENSION FOLLOWED BY INTRACRANIAL HYPOTENSION SUBSEQUENT TO EPIDURAL PATCH PROCEDURE


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Debbağ S., Sarıcaoğlu F.

ARUD2021, İzmir, Turkey, 30 April - 02 May 2021, pp.291

  • Publication Type: Conference Paper / Summary Text
  • City: İzmir
  • Country: Turkey
  • Page Numbers: pp.291
  • Hacettepe University Affiliated: Yes

Abstract

Background and Goal of Study / Background: An epidural blood patch is an option for postdural

puncture headache treatment that is not responsive to conservative therapy. Rebound

intracranial hypertension is a possible complication that can occur after an epidural blood

patch.

Materials and Methods: We report a 15-year-old patient with Burkitt lymphoma who had

complaints of headache after the last dose of the intrathecal chemotherapy. The severity of

the headache was increased when standing up and alleviated by lying down. These symptoms

were accompanied by nausea and photophobia. MRI studies showed bilateral subdural

effusions and findings that support intracranial hypotension due to dural puncture. The

epidural blood patch was applied to the patient who did not respond to the medical

conservative treatment. After the procedure, there was a marked reduction in the severity of

the headache. Control brain CT was performed on the fourth day due to an increase in the

severity of the headache accompanied by vomiting. Radiological findings showed a decrease

in the subdural effusion accompanied by midline shift and elongated cerebellar tonsils

through the foramen magnum. Hypertonic fluid and acetazolamide were started in order to

relieve the severity of the intracranial pressure. On the fourth day of the medical treatment,

the complaints continued and a new brain MRI was acquired, the new brain MRI showed a

decrease in the midline shift and increasing subdural effusion with the herniation of the

cerebellar tonsils. Despite the absence of a neurologic deficit, the recommendation of the

neurosurgery department was to surgical intervention due to the enlargement of the subdural

effusion and herniation. The patient's complaints decreased after the surgery and also there

were no complaints of headache in the 1st, 6th, and 12th months after the surgery.

Results and Discussion / Discussion: Although rebound intracranial hypertension is reported,

the problems that may be caused by treatments were not emphasized. In this case, we

underline the problems that may face the medical staff in the postprocedural period

Conclusion(s): Rebound intracranial hypertension is a complication that can occur after

epidural patch procedures and management should be cautious and the patient should be

monitored very closely to avoid the possibility of more serious complications.