Clinically atypical cases with normal brain MR imaging should be investigated to localize the leak. If the leak is localized, directed EPBs should be considered, followed by fibrin sealant or neurosurgery if necessary. If these are unsuccessful, non-invasive MR myelography, radionuclide cisternography, MR myelography with intrathecal gadolinium, or computed tomography with myelography should be used to localize the leak. If the patient remains symptomatic, up to three non-directed lumbar epidural blood patches (EBPs) should be considered. For typical cases, we recommend brain magnetic resonance (MR) imaging with gadolinium to confirm the diagnosis, and conservative measures for up to two weeks. Based on the available literature and expert opinion, we have developed recommendations for the diagnosis and management of SIH. Patients without a driver will be rescheduled for another day.A literature search found no clinical trials or guidelines addressing the management of spontaneous intracranial hypotension (SIH). After the procedure you will need someone to drive you home. Any insurance questions can be answered by your referring physician. She will provide you with detailed instructions on how to prepare for the upcoming procedure. You will be asked to provide information regarding you current problem, past medical history, and medications. Once scheduled for the procedure, you will be contacted by one of the spine nurses. Once the needle has reached the epidural space, a small amount of contrast dye is injected into the area to ensure proper needle placement and the blood is then injected.įollowing the procedure, the patient is expected to lay flat for approximately an hour then discharged home to rest. Fluoroscopy (live x-ray) is used to aid the radiologist in guiding the needle directly into the epidural space. The injection is done with the patient lying on his or her abdomen. Placement of the blood forms a barrier within the epidural space to seal off the leak. This type of headache is positional in nature, usually worsened by sitting or standing and relieved by lying down. This procedure is commonly done to treat spinal headache, usually resulting from of a loss of CSF following a lumbar puncture or myelogram. What is an epidural blood patch and how is it performed?Īn epidural blood patch is a relatively simple procedure in which blood drawn from an intravenous line in your arm is injected into the epidural space in your spine.

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