RT Journal Article
SR Electronic
T1 Rescue Epidural Saline Patch for Comatose Patients With Refractory Convexity Spontaneous Subacute Subdural Hematoma
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP e200137
DO 10.1212/CPJ.0000000000200137
VO 13
IS 2
A1 Mickaela Roy
A1 Stephane Welschbillig
A1 Marie Cantier
A1 Dorian Chauvet
A1 Pierre Bourdillon
A1 Nicolas Engrand
YR 2023
UL http://cp.neurology.org/content/13/2/e200137.abstract
AB Objectives Convexity spontaneous subacute subdural hematoma (CSSSH) frequently relapse after one or more surgical drainages. This may be due to spontaneous intracranial hypotension (SIH), for which the gold standard treatment is the epidural blood patch. In this study, we report 4 cases of refractory CSSSH treated with rescue epidural saline patch, although history and imaging studies showed no evidence of SIH.Methods All 4 patients received a lumbar saline epidural rescue patch for consciousness impairment associated with refractory CSSSH, and one is particularly detailed. No patient had typical radiologic signs of SIH or, on the contrary, uncal herniation that could have indicated intracranial hypertension.Results The Glasgow Coma Scale score improved significantly in the days after application of the epidural patch in 3 patients. All patients showed an improvement of the CT scan. Two patients underwent lumbar pressure measurement to confirm low values before the epidural injection, and for one, the intrathecal pressure profile during epidural patching is presented.Discussion An epidural patch may be considered in managing CSSSH with no uncal herniation, even in the absence of signs of SIH on brain and spinal imaging. Whether it should be combined with surgical evacuation or used as first-line therapy remains to be determined.