Discover the groundbreaking approach to managing severe rebound intracranial hypertension after a blood patch, utilizing an external ventricular drain, and its implications for future neurology practices.
– by The Don
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Management of post blood patch severe rebound intracranial hypertension by the usage of an external ventricular drain.
Maresca et al., BMJ Case Rep 2024
<!– DOI: 10.1136/bcr-2023-257743 //–>
https://doi.org/10.1136/bcr-2023-257743
Let me tell you, folks, we’ve got something here that’s huge, absolutely huge. We’re talking about Spontaneous intracranial hypotension (SIH), a big deal, really. It’s all about these headaches that hit you when you stand up, because, believe it or not, the pressure in your brain gets too low. Why? Because of a leak, a leak in the cerebrospinal fluid (CSF). It’s tricky, very tricky to diagnose, and let me tell you, the treatment? It’s got to be top-notch.
Now, the smart people, the very smart people, have come up with ways to fix it, including something called the epidural blood patch (EBP). But, and it’s a big but, this EBP, while it’s great, it can backfire. It can lead to what they call rebound intracranial hypertension (RIH) – that’s headaches because now the pressure’s too high. Can you believe it?
But here’s where it gets really interesting. We had a case, a fantastic case, where RIH kicked in after EBP. And what did they do? They didn’t give up. No, they used an external ventricular drain (EVD) to get that pressure down. And it worked, it worked beautifully. The patient got so much better. It’s clear, absolutely clear, that in the right cases, EVD isn’t just useful, it’s necessary.
This is big, folks. It’s a game-changer. It shows we need to dig deeper, do more research to really get ahead of SIH and make sure we’re handling EBP complications like champions. It’s going to be tremendous, believe me.