Fræðigrein

Læknablaðið 2007; 93: 487-91

Abstract: Thirty three year old woman came to the emergency room with of 3 days history of worsening headache which was relived by lying down. Examination was normal. Magnetic Resonance Imaging (MRI) of the head showed an enhancement of the meninges. No pressure could be measured during lumbar puncture and cerebrospinal fluid (CSF) was obtained by elevating the patient´s head. There was an elevation of protein in the CSF without signs of infection or inflammation. Computerised tomography (CT) myelogram showed a prominent leak from the 2nd right cervical nerve sheath. A blood patch was done at this level with some improvement of symptoms. The patient was readmitted four days later as the headache had worsened. A blood patch was repeated at the same level with limited results. Therefore a fibrinogen patch was done at the same level, of which the effect lasted only 24 hours. A repeated CT myelogram showed a leak from the left 8th cervical and 1st thoracic nerve sheets, but not from the 2nd right cervical nerve sheath. Blood and fibrinogen patches were done at these levels repeatedly with limited results. Therefore, a MRI of cervical-thoracic spine was done which showed signs of previous blood patch at the 1st left thoracic nerve sheath but no sign of a patch over the 8th left cervical nerve sheath. A fibrinogen patch was done at this level. The patient became symptom free and was finally discharged home. We present a case of complicated spontaneous intracranial hypotension and review of the literature.