Spontaneous intracranial hypotension is characterized by occult cerebrospinal fluid (CSF) leak and subsequent CSF hypovolemia, resulting in brain sag and downward traction of neural structures, which in turn leads to orthostatic headache. Less frequent symptoms are taste alterations, limb paresthesia, behavioral changes, Parkinsonian-like symptoms, and even coma. Treatments include conservative therapy such as bed rest, oral and intravenous hydration, caffeine, steroids, analgesics, and an epidural blood patch (EBP). Here, we describe a case of excellent relief of symptoms after thoracic epidural blood patch in a patient with a disturbed consciousness and behavioral changes due to severe spontaneous intracranial hypotension.
Methods
Diagnosis was based on the patient’s symptoms and neuroimaging findings, which included brain magnetic resonance imagingand computerized tomography (CT) myelography.
All procedures were performed under fluoroscopic guidance. Thoracic Epidural space was identified by the loss of resistance technique with air. Contrast media was injected into the epidural space for confirmation. At this time, autologous blood was collected under sterile condition and slowly infused into the epidural space. After the procedure, patient was monitored for any adverse effects.
Results
The brain stem symptoms such as 3rd nerve palsy and mental change developed rapidly and we thought that were posterior sagging symptom because of CSF leakage.EBP was performed to prevent CSF leakage, and then the brain sagging was reversed.
Conclusion
We describe a case of excellent relief of symptoms after thoracic epidural blood patch in a patient with a disturbed consciousness and behavioral changes due to severe spontaneous intracranial hypotension.

THORACIC EPIDURAL BLOOD PATCH FOR A PATIENT WITH A DISTURBED CONSCIOUSNESS AND BEHAVIORAL CHANGES DUE TO SEVERE SPONTANEOUS INTRACRANIAL HYPOTENSION: A CASE REPORT