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<p>Spontaneous intracranial hypotension (SIH) is a highly disabling neurological syndrome. It occurs secondary to a spinal cerebrospinal fluid leak (CSF) caused by a dural tear, a leaking meningeal diverticulum, or a CSF-venous fistula. SIH is rarely reported in patients with end-stage renal failure (ESRF) on haemodialysis, where fluid shifts may exacerbate CSF pressure dysregulation.&#xa0;We present the case of a female in her twenties referred for a non-targeted epidural blood patch. She had confirmed spontaneous intracranial hypotension, bilateral subdural haemorrhages and a CSF leak of unknown origin on MRI imaging. She had a background of end-stage renal failure and was on intermittent haemodialysis at the time of referral. This is a rare, potentially life-threatening condition with only two previous case reports in the literature in this patient cohort [<CitationRef CitationID="CR1">1</CitationRef>, <CitationRef CitationID="CR2">2</CitationRef>].&#xa0;This case required co-ordinated, multi-disciplinary care between multiple specialities, including anaesthetics, nephrology, neuroradiology, neurology and neurosurgery. We performed an early, non-targeted epidural blood patch, followed by a second non-targeted epidural blood patch four weeks later, with positive results.</p>

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Non-targeted thoracic epidural blood patch for spontaneous intracranial hypotension complicated by bilateral subdural haemorrhages in a patient with end-stage renal failure: case based review

  • 期刊论文

  • 发表日期：

    2026年2月24日

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  • Sorcha O’Rourke,
  • M. Moustafa,
  • T. Tan,
  • B. Griffin,
  • A. Sherwin

摘要

Spontaneous intracranial hypotension (SIH) is a highly disabling neurological syndrome. It occurs secondary to a spinal cerebrospinal fluid leak (CSF) caused by a dural tear, a leaking meningeal diverticulum, or a CSF-venous fistula. SIH is rarely reported in patients with end-stage renal failure (ESRF) on haemodialysis, where fluid shifts may exacerbate CSF pressure dysregulation. We present the case of a female in her twenties referred for a non-targeted epidural blood patch. She had confirmed spontaneous intracranial hypotension, bilateral subdural haemorrhages and a CSF leak of unknown origin on MRI imaging. She had a background of end-stage renal failure and was on intermittent haemodialysis at the time of referral. This is a rare, potentially life-threatening condition with only two previous case reports in the literature in this patient cohort [1, 2]. This case required co-ordinated, multi-disciplinary care between multiple specialities, including anaesthetics, nephrology, neuroradiology, neurology and neurosurgery. We performed an early, non-targeted epidural blood patch, followed by a second non-targeted epidural blood patch four weeks later, with positive results.