Akademik Veri Yönetim Sistemi
ARUD2021, İzmir, Türkiye, 30 Nisan - 02 Mayıs 2021, ss.291
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.