Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.024
Brazilian Journal of Anesthesiology
Case Report

Epidural blood patch for the treatment of liquor hypotension after intrathecal chemotherapy in a 10-year-old: case report

Rui Silva, Mónica Oliveira, Fátima Abreu, Maria João Vaz

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Abstract

Background and objectives
An epidural blood patch is used to treat postdural puncture and liquor hypotension headache. We report the use of an epidural blood patch in a critical pediatric patient.

Case report
A 10-year-old girl with acute leukemia developed venous cerebral thrombosis with hemorrhagic transformation one month after intrathecal chemotherapy. Given the unusual clinical and imagiological evolution even after decompressive craniectomy, we suspected cerebrospinal fluid hypotension. Spine imaging revealed signs of post-lumbar puncture fistula; we hence performed a blind blood patch.

Conclusions
Recognizing cerebrospinal fluid hypotension in critical pediatric patients is important. Less-conventional life-saving measures, such as a blind blood patch, may be considered in such patients.

Keywords

Blood patch, epidural;  Chemotherapy;  Intracranial hypotension;  Cerebrospinal fluid leak

References

1 E.C. Williams, B.R. Buchbinder, S. Ahmed, T.A. Alston, J.P. Rathmell, J. Wang Spontaneous intracranial hypotension: Presentation, diagnosis, and treatment Anesthesiology, 121 (2014), pp. 1327-1333

2 L. Roy, D. Vischoff, J. Lavoie Epidural blood patch in a seven-year-old child Can J Anaesth., 42 (1995), pp. 621-624

3 MA Kowbel, VK Comfort Caudal epidural blood patch for the treatment of a paediatric subarachnoid-cutaneous fistula Can J Anaesth, 42 (1995), pp. 625-627

4 C. Ahn, E. Lee, J.W. Lee, C.G. Chee, Y. Kang, H.S. Kang Two-site blind epidural blood patch versus targeted epidural blood patch in spontaneous intracranial hypotension J Clin Neurosci, 62 (2019), pp. 147-154

5 P. Ylönen, H. Kokki Management of postdural puncture headache with epidural blood patch in children Paediatr Anaesth, 12 (2002), pp. 526-529

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