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Epidural dextran–40 and paramethasone injection for treatment of spontaneous intracranial hypotension

[L’injection péridurale de dextran–40 et de paraméthasone pour traiter l’hypotension intracrânienne spontanée]

From the Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínic, Barcelona, Spain.

Address correspondence to: Dr. Ivan Bel, Hospital Clínic, Department of Anesthesiology, Intensive Care and Pain Management, 170 Villarroel St. Barcelona, Spain, 08036. Phone: 34-93-2275558; Fax: 34-93-4517553; E-mail: ibelmarc{at}hotmail.com

Purpose: This report describes treatment with epidural dextran–40 and paramethasone injection of postural headache resulting from spontaneous intracranial hypotension in a pregnant patient.

Clinical features: A 39-yr-old pregnant woman consulted the pain clinic for the assessment of a debilitating postural headache which was non-responsive to conventional analgesic treatment. Clinical findings and cranial magnetic resonance imaging indicated the diagnosis of spontaneous intracranial hypotension syndrome. Treatment with an epidural blood patch was not undertaken for several reasons. A lumbar epidural injection with dextran-40 and paramethasone led to a significant improvement in the symptoms and allowed a progressive discontinuation of adjuvant treatment with oral steroids, with complete resolution of symptoms.

Conclusion: We report a case of spontaneous intracranial hypotension in a pregnant patient successfully treated by epidural injection of dextran-40 and paramethasone, with adjuvant oral steroid therapy. Clinical trials are warranted to establish the efficacy of this treatment as an alternative to the epidural blood patch administration.