ESRA Academy. Ng A. Sep 8, 2016; 138578; 0454 Topic: Local anaesthesia
Dr. Andy Ng
Dr. Andy Ng

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Background and Aims:

Spontaneous intracranial hypotension (SIH) is a rare cause of headache.  A CSF leak leads to descent of the brain, causing traction on the meninges and cerebral veins, leading to pain.

SIH has an incidence of 4 in 100 000 patients, affecting women more than men. It classically presents with orthostatic headache, either of sudden onset, or over a few days. Other clinical features include neck stiffness, photophobia, tinnitus and nausea. There may be no obvious triggering event. Investigation usually involves CT and MRI scanning. While there are classical radiological features, their absence does not preclude a diagnosis of SIH.

We describe the case of a patient presenting with sudden onset orthostatic headache without clear precipitant. We report this case in the hope that our anaesthetic colleagues will be willing to administer treatment in a timely manner, thereby reducing morbidity caused by this debilitating, reversible condition.


The neurology team felt SIH to be the likely diagnosis. A lumbar puncture was performed to measure the CSF pressure, and blind epidural blood patch was simultaneously administered.


That afternoon, the patient was asked to stand for the first time since the procedure, which she did without reproducing her symptoms. At day ten, she reported ongoing benefit, having returned to work. Weeks later she reported complete resolution of symptoms.


SIH remains an underdiagnosed but treatable condition. Case reports show epidural blood patch to be effective, particularly if a CSF leak is found and targeted. However, knowledge of this condition and its treatment are not widespread. 

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