Spontaneous Intracranial Hypotension (SIH) Pain Relief with Lumbar Epidural Blood Patch (EBP) in a Patient with Cancer: A Case Report

Abstract

BACKGROUND: Spontaneous intracranial hypotension (SIH) is a challenging chronic headache pain condition that can severely debilitate patients. It can be caused by any etiology in which intracranial cerebrospinal fluid (CSF) outflow surpasses CSF production. Conservative first-line therapy typically involves caffeine, hydration, medications, bed rest, and/or abdominal binding. Refractory cases involve epidural blood patch and surgical repair. To date, there have been no published studies or case reports on the treatment of SIH using epidural blood patch (EBP) in patients with cancer. We present a case demonstrating the utility of EBP in the treatment of refractory SIH in a patient with cancer. CASE REPORT: A 65-year-old woman with lung adenocarcinoma presented with refractory SIH of 2 years. She failed conservative first-line therapies and was evaluated by multiple services without relief. She then received an EBP with 75% relief of symptoms, and 100% relief of all symptoms with a repeat EBP. CONCLUSIONS: Given its overall safety and effectiveness, EBP should be considered as a treatment option in patients with cancer who present with SIH. KEY WORDS: Cancer, cerebrospinal fluid, chronic pain, epidural blood patch, headache, oncology, spontaneous intracranial hypotension