Intracranial Hypotension TreatmentIntracranial Hypotension Treatment should not usually be difficult. Like a lot of severe headache disorders, the main difficulty is arriving at the diagnosis. Usually after diagnosis, a day or two of bed-rest with increased fluid intake (about 2 litres per day of water) and paracetamol / acetaminophen or a non-steroidal anti-inflammatory are suggested. The response to this, however, is not usually dramatic in spontaneous cerebrospinal fluid leak syndromes. There are no randomised trials of this type of conservative approach although a small number will improve spontaneously. Similarly Intravenous caffeine (usually about 500mg over one to two hours in 0.9% saline) is not usually dramatic in its response. This leaves the epidural blood patch. Epidural Blood PatchEpidural Blood Patching is the most effective means of treating spontaneous low pressure headaches due to cerebrospinal fluid leak.The first epidural blood patch procedures used about 0.5 to 1.0ml of blood! Sometimes up to 100ml have been used in certain circumstances - this acts to increase intra-spinal pressure which then leads to a rise in intracranial pressure. I usually use between 10 and 20mls, depending on the the ease with which blood patch can be performed. What if epidural blood patch does not work?If there is a clearly defined source of CSF leakage, such as a leaking nerve root sheath in the cervical spine, then a neurosurgeon may be able to operate and seal off the leak with a metal clip or other method of "dural" repair.It would normally be required that imaging (CT myelogram or MR, heavily T2 weighted, myelography) will have shown the focus of CSF leakage. These nerve root sheath repair procedures are not commonly performed, in part due to the usual success of an epidural blood patch or a series of epidural blood patches.
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