Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.
Bibliographic record
Abstract
Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF).Treatment is directed at sealing the site of leak, which is often difficult to localize.We present a case of near fatal SIH that was treated with thoracic epidural blood patching.A 47-yearold male presented with orthostatic headache and bilateral cranial nerve VI palsies progressing over several weeks.Brain magnetic resonance (MR) imaging showed features typical of SIH and identified an epidural collection stretching from spinal levels C6 to T4, but further imaging with MR myelography and radionuclide cisternography failed to identify a precise site of leak.The patient worsened in the hospital requiring craniotomy for evacuation of an evolving subdural hematoma (SDH).Epidural blood patch was performed at the T1-2 level, the presumed location of the leak due to presence of a bone spur on computed tomography and the large corresponding CSF collection.This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his SDH.Through this case and review of the literature, we aim to demonstrate that directed cervical or thoracic blood patching should be considered for SIH as an alternative to the conventional lumbar blood patch.KEywoRds: Epidural blood patch, Intracranial hypotension, Thoracic ÖZ Spontan intrakraniyal hipotansiyonun (SIH) nedeni beyin omurilik sıvısının (BOS) spinal sızıntısıdır.Tedavi, sızıntı bölgesinin kapatılmasını hedefler ama bu bölgenin bulunması genellikle zordur.Torasik epidural kan yaması konmasıyla tedavi edilen neredeyse ölümcül bir SIH olgusu sunuyoruz.47 yaşında bir erkek hasta birkaç haftadır ilerleyen ortostatik başağrısı ve bilateral VI. kraniyal sinir paralizisiyle geldi.Beyin manyetik rezonans (MR) görüntülemesi SIH için tipik özellikler gösterdi ve spinal C6 ila T4 seviyeleri arasında bir epidural sıvı toplanmasına işaret etti ama MR miyelografi ve radyonüklid sisternografi ile yapılan ek incelemeler tam olarak sızıntı yerini gösteremedi.Hastanın durumu hastanede kötüleşti ve giderek büyüyen bir subdural hematomun (SDH) boşaltılması için kraniyotomi gerekti.Bilgisayarlı tomografide bir kemik çıkıntısı bulunduğundan ve karşılık gelen büyük bir BOS birikimi olduğundan sızıntının varsayılan konumu olan T1-2 seviyesine epidural kan yaması uygulandı.Bunun sonucunda başağrısı ve kraniyal sinir paralizileri hızla iyileşti ve sonrasında SDH tamamen geçti.Bu olgu ve literatür derlemesi yoluyla servikal ve torasik kan yaması yerleştirmenin SIH durumunda konvansiyonel lumber kan yaması yerleştirmeye bir alternatif olarak düşünülmesi gerektiğini belirtiyoruz.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".